Association of computed tomography morphologic criteria with pathologic response and survival in patients treated with bevacizumab for colorectal liver metastases.
Association of computed tomography morphologic criteria with pathologic response and survival in patients treated with bevacizumab for colorectal liver metastases.
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DOI：
10.1001/jama.2009.1755
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发表时间：
2009-12-02
影响因子：
120.7
通讯作者：
Loyer, Evelyne M.
中科院分区：
文献类型：
--
作者：
Chun, Yun Shin;Vauthey, Jean-Nicolas;Boonsirikamchai, Piyaporn;Maru, Dipen M.;Kopetz, Scott;Palavecino, Martin;Curley, Steven A.;Abdalla, Eddie K.;Kaur, Harmeet;Charnsangavej, Chusilp;Loyer, Evelyne M.
开发了用于评价肿瘤缓解的标准标准，即实体瘤缓解评价标准（RECIST），以评估细胞毒性化疗后的肿瘤缩小情况，并且可能局限于评估对具有细胞抑制作用机制的生物制剂的缓解情况。基于在接受含贝伐珠单抗化疗方案治疗的结直肠肝转移（CLM）患者中通过计算机断层扫描（CT）观察到的形态学变化，验证新的肿瘤缓解标准。从2004年到2007年，在一家综合性美国癌症中心对50例术前化疗（包括贝伐单抗）后接受肝切除术的患者进行了234例CLM分析;末次随访日期为2008年3月。所有患者在术前治疗开始和结束时均接受常规增强CT检查。三位独立的盲法放射科医生根据转移瘤从边缘不清的异质性肿块转变为边缘清晰的同质性病变，评价图像的形态学反应。这些标准在一个单独的队列中进行了验证，该队列包括82例接受含贝伐珠单抗化疗的不可切除CLM患者。使用形态学标准和RECIST确定的缓解与切除肝脏标本的病理学缓解和患者生存率相关。三位放射科医师之间对形态学变化评分的观察者间一致性良好（κ=0.68-0.78; 95%置信区间，0.51-0.93）。在形态学最佳、不完全和无反应的切除肿瘤标本中，残留肿瘤细胞的中位百分比分别为20%（四分位距[IQR]，10%-30%）、50%（IQR，30%-60%）和70%（IQR，60%-70%）（P<.001）。对于RECIST部分缓解、疾病稳定和疾病进展，残留肿瘤细胞的中位百分比分别为30%（IQR，10%-60%）、50%（IQR，20%-70%）和70%（IQR，65%-70%）（P= 0.04）。在接受肝切除术的患者中，中位总生存期尚未达到最佳形态学缓解和35个月（95%CI，20.2至29.8个月）不完全或无形态学缓解（P= 0.03）。在验证队列中，具有最佳形态学缓解的患者的中位总生存期为31个月（95% CI，26.8至35.2个月），而不完全或无形态学缓解的患者的中位总生存期为19个月（95% CI，14.6至23.4个月）（P= 0.009）。在手术组和验证组中，RECIST与生存率均无相关性。在接受含贝伐珠单抗化疗的CLM患者中，基于CT的形态学标准与病理反应和总生存率有统计学显著相关性。
The standard criteria used to evaluate tumor response, the Response Evaluation Criteria in Solid Tumors (RECIST), were developed to assess tumor shrinkage after cytotoxic chemotherapy and may be limited in assessing response to biologic agents, which have a cytostatic mechanism of action.. To validate novel tumor response criteria based on morphologic changes observed on computed tomography (CT) in patients with colorectal liver metastases (CLM) treated with bevacizumab-containing chemotherapy regimens. 234 CLM were analyzed in 50 patients who underwent hepatic resection after preoperative chemotherapy that included bevacizumab at a comprehensive US cancer center from 2004 to 2007; date of last follow-up was March 2008. All patients underwent routine contrast-enhanced CT at the start and end of preoperative therapy. Three blinded, independent radiologists evaluated images for morphologic response, based upon metastases changing from heterogeneous masses with ill-defined margins into homogeneous lesions with sharp borders. These criteria were validated with a separate cohort of 82 patients with unresectable CLM treated with bevacizumab-containing chemotherapy. Response determined using morphologic criteria and RECIST was correlated with pathologic response in resected liver specimens and with patient survival. Interobserver agreement for scoring morphologic changes was good among three radiologists (κ=0.68–0.78; 95% confidence interval, 0.51–0.93). In resected tumor specimens with morphologic optimal, incomplete, and no response, the median percentages of residual tumor cells were 20% (interquartile range [IQR], 10%–30%), 50% (IQR, 30%–60%), and 70% (IQR, 60%–70%), respectively (P<.001). With RECIST partial response, stable disease, and progressive disease, the median percentages of residual tumor cells were 30% (IQR, 10%–60%), 50% (IQR, 20%–70%), and 70% (IQR, 65%–70%), respectively (P=.04). Among patients who underwent hepatic resection, median overall survival was not yet reached with optimal morphologic response and 35 months (95% CI, 20.2 to 29.8 months) with incomplete or no morphologic response (P=.03). In the validation cohort, patients with optimal morphologic response had median overall survival of 31 months (95% CI, 26.8 to 35.2 months) compared to 19 months (95% CI, 14.6 to 23.4 months) with incomplete or no morphologic response (P=.009). RECIST did not correlate with survival in neither the surgical nor validation cohort. Among patients with CLM treated with bevacizumab-containing chemotherapy, CT-based morphologic criteria had a statistically significant association with pathologic response and overall survival.
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影响因子：
19.7
作者：
MURAMATSU, Y;TAKAYASU, K;HIROHASHI, S
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45.3
作者：
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19.7
作者：
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