Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115, USA.
AJR Am J Roentgenol. 2012 Feb;198(2):359-63. doi: 10.2214/AJR.11.7015.
The purpose of this study was to assess the usefulness of CT-derived tumor volume, with control for other prognostic factors, for stratifying survival after surgery-based multimodality treatment of a large cohort of patients with epithelial malignant pleural mesothelioma.
We retrospectively reviewed 338 patients with mesothelioma who underwent extrapleural pneumonectomy between 2001 and 2007. The study cohort comprised 88 patients with epithelial subtype tumors, DICOM-format CT scans, and data regarding neoadjuvant and adjuvant therapy. Tumor volume was calculated, and Kaplan-Meier survival and Cox regression analyses were performed to compare the estimated survival functions of patient subgroups based on volume and other covariates related to outcome (sex, age, preoperative platelet count, hemoglobin concentration, WBC count, clinical and pathologic TNM category, and administration of neoadjuvant and adjuvant therapy). A multivariate regression model was derived on the basis of the most significant univariate predictors.
The median estimated tumor volume was 319 cm(3) (range, 4-3256 cm(3)). In univariate analysis, tumor volume, hemoglobin concentration, platelet count, pathologic TNM category, and administration of adjuvant chemotherapy or radiation therapy met the criteria for inclusion in the reverse stepwise regression analysis. In the final model, tumor volume, hemoglobin concentration, and administration of adjuvant chemotherapy or radiotherapy were identified as independently associated with overall survival.
With control of prognostic covariates, CT-derived tumor volume can be used to stratify survival of patients with epithelial mesothelioma after extrapleural pneumonectomy and should be included in prognostic evaluation of patients for whom resection is being considered.
本研究旨在评估 CT 测量的肿瘤体积（控制其他预后因素）在分层上皮型恶性胸膜间皮瘤患者手术后多模式治疗的生存中的作用。
我们回顾性分析了 2001 年至 2007 年间行胸膜外全肺切除术的 338 例间皮瘤患者。研究队列包括 88 例上皮型肿瘤患者，这些患者均具有 DICOM 格式的 CT 扫描结果以及关于新辅助和辅助治疗的数据。计算了肿瘤体积，并进行 Kaplan-Meier 生存分析和 Cox 回归分析，以比较基于体积和与结局相关的其他协变量（性别、年龄、术前血小板计数、血红蛋白浓度、白细胞计数、临床和病理 TNM 分期以及新辅助和辅助治疗的应用）的患者亚组的估计生存函数。基于最显著的单变量预测因子，建立了多变量回归模型。
中位估计肿瘤体积为 319cm³（范围：4-3256cm³）。在单变量分析中，肿瘤体积、血红蛋白浓度、血小板计数、病理 TNM 分期和辅助化疗或放疗的应用符合反向逐步回归分析的纳入标准。在最终模型中，肿瘤体积、血红蛋白浓度和辅助化疗或放疗的应用被确定为与总生存相关的独立因素。
在控制预后协变量的情况下，CT 测量的肿瘤体积可用于分层上皮型间皮瘤患者行胸膜外全肺切除术后的生存，并应纳入正在考虑切除的患者的预后评估中。
