Imaging Biomarkers of Tumor Response in Neuroendocrine Liver Metastases Treated with Transarterial Chemoembolization: Can Enhancing Tumor Burden of the Whole Liver Help Predict Patient Survival?
Imaging Biomarkers of Tumor Response in Neuroendocrine Liver Metastases Treated with Transarterial Chemoembolization: Can Enhancing Tumor Burden of the Whole Liver Help Predict Patient Survival?
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DOI：
10.1148/radiol.2016160838
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发表时间：
2017-06
期刊：
影响因子：
19.7
通讯作者：
Duran R
中科院分区：
文献类型：
--
作者：
Sahu S;Schernthaner R;Ardon R;Chapiro J;Zhao Y;Sohn JH;Fleckenstein F;Lin M;Geschwind JF;Duran R
研究全肝增强肿瘤负荷[ETB]是否可以作为影像学生物标志物，并帮助预测生存率，优于世界卫生组织（WHO）、实体肿瘤反应评估标准（RECIST）、改良RECIST （mRECIST）和欧洲肝脏研究协会（EASL）方法，用于首次经动脉化疗栓塞（TACE）手术后多灶、双叶神经内分泌肝转移（NELM）患者。这项符合hipaa标准、经机构审查委员会批准的回顾性研究纳入了51例接受TACE治疗的多灶双叶NELM患者（平均年龄57.8岁±13.2岁；范围13.5-85.8岁）。对比材料增强磁共振成像在基线和第一次TACE后测量最大面积（WHO）、最长直径（RECIST）、最长增强直径（mRECIST）、最大增强面积（EASL）和最大增强体积（ETB）。使用三维软件，以正常肝脏感兴趣区域的信号强度大于2个标准差来测量ETB。采用WHO、RECIST、mRECIST和EASL方法根据各自的标准评估反应。对于ETB反应，使用赤池信息标准分析了至少30%，50%和65%的增强减少。生存分析包括Kaplan-Meier曲线和Cox回归。5.9% （WHO标准）、2.0% （RECIST标准）、25.5% （mRECIST标准）和23.5% （EASL标准）的患者出现治疗反应。在30%，50%和65%的临界值下，ETB反应分别在60.8%，39.2%和21.6%的患者中出现，并且是唯一与反应者和无反应者之间生存差异相关的生物标志物（45.0个月vs 10.0个月，84.3个月vs 16.7个月，85.2个月vs 21.2个月，分别；P < 0.01）。50%的临界值提供了最佳的生存模型（风险比[HR]: 0.2； 95%可信区间[CI]: 0.1, 0.4）。在多变量分析中，ETB反应是生存的独立预测因子（HR: 0.2; 95% CI: 0.1, 0.6）。容积ETB是多灶双叶NELM患者在第一次TACE手术后的早期治疗反应生物标志物和生存指标。
To investigate whether whole-liver enhancing tumor burden [ETB] can serve as an imaging biomarker and help predict survival better than World Health Organization (WHO), Response Evaluation Criteria in Solid Tumors (RECIST), modified RECIST (mRECIST), and European Association for the Study of the Liver (EASL) methods in patients with multifocal, bilobar neuroendocrine liver metastases (NELM) after the first transarterial chemoembolization (TACE) procedure. This HIPAA-compliant, institutional review board–approved retrospective study included 51 patients (mean age, 57.8 years ± 13.2; range, 13.5–85.8 years) with multifocal, bilobar NELM treated with TACE. The largest area (WHO), longest diameter (RECIST), longest enhancing diameter (mRECIST), largest enhancing area (EASL), and largest enhancing volume (ETB) were measured at baseline and after the first TACE on contrast material–enhanced magnetic resonance images. With three-dimensional software, ETB was measured as more than 2 standard deviations the signal intensity of a region of interest in normal liver. Response was assessed with WHO, RECIST, mRECIST, and EASL methods according to their respective criteria. For ETB response, a decrease in enhancement of at least 30%, 50%, and 65% was analyzed by using the Akaike information criterion. Survival analysis included Kaplan-Meier curves and Cox regressions. Treatment response occurred in 5.9% (WHO criteria), 2.0% (RECIST), 25.5% (mRECIST), and 23.5% (EASL criteria) of patients. With 30%, 50%, and 65% cutoffs, ETB response was seen in 60.8%, 39.2%, and 21.6% of patients, respectively, and was the only biomarker associated with a survival difference between responders and nonresponders (45.0 months vs 10.0 months, 84.3 months vs 16.7 months, and 85.2 months vs 21.2 months, respectively; P < .01 for all). The 50% cutoff provided the best survival model (hazard ratio [HR]: 0.2; 95% confidence interval [CI]: 0.1, 0.4). At multivariate analysis, ETB response was an independent predictor of survival (HR: 0.2; 95% CI: 0.1, 0.6). Volumetric ETB is an early treatment response biomarker and surrogate for survival in patients with multifocal, bilobar NELM after the first TACE procedure.