Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
Br J Radiol. 2012 Sep;85(1017):1243-9. doi: 10.1259/bjr/27266976.
The objective of this study was to determine whether, in patients with prostate cancer (PCa) bone metastases receiving chemotherapy, early post-treatment changes on CT are reproducible and associated with clinical outcomes.
Blinded to outcomes, two radiologists with 1 year and 5 years of experience independently reviewed CTs obtained before and 3 months after chemotherapy initiation in 38 patients with bone metastases from castration-resistant PCa, recording the size, matrix and attenuation of ≤5 lesions; presence of new lesions, extraosseous components, periosteal reactions and cortical thickening; and overall CT assessment (improved, no change or worse). Kappa statistics were used to assess inter-reader agreement; the Kruskal-Wallis test and Cox regression model were used to evaluate associations.
Inter-reader agreement was low/fair for size change (concordance correlation coefficient=0.013), overall assessment and extraosseous involvement (κ=0.3), moderate for periosteal reaction and cortical thickening (κ=0.4-0.5), and substantial for CT attenuation (κ=0.7). Most metastases were blastic (Reader 1, 58%; Reader 2, 67%) or mixed lytic-blastic (Reader 1, 42%; Reader 2, 34%). No individual CT features correlated with survival. Readers 1 and 2 called the disease improved in 26% and 5% of patients, unchanged in 11% and 21%, and worse in 63% and 74%, respectively, with 64% interreader agreement. Overall CT assessment did not correlate with percentage change in prostate-specific antigen level. For the more experienced reader (Reader 2), patients with improved or unchanged disease had significantly longer median survival (p=0.036).
In PCa bone metastases, interreader agreement is low in overall CT post-treatment assessment and varies widely for individual CT features. Improved or stable disease identified by an experienced reader is statistically associated with longer survival.
本研究旨在确定在接受化疗的前列腺癌（PCa）骨转移患者中，治疗后早期的 CT 变化是否具有可重复性，并与临床结局相关。
在不了解结局的情况下，两名具有 1 年和 5 年经验的放射科医生分别独立评估了 38 例接受去势抵抗性 PCa 骨转移化疗的患者化疗前和 3 个月时的 CT，记录≤5 个病灶的大小、基质和衰减；新病灶、骨外成分、骨膜反应和皮质增厚的存在情况；以及整体 CT 评估（改善、无变化或恶化）。使用 Kappa 统计评估读者间的一致性；采用 Kruskal-Wallis 检验和 Cox 回归模型评估相关性。
两名读者在大小变化（一致性相关系数=0.013）、整体评估和骨外累及（κ=0.3）方面的一致性较低/一般，在骨膜反应和皮质增厚（κ=0.4-0.5）方面的一致性为中度，在 CT 衰减方面的一致性较高（κ=0.7）。大多数转移灶为成骨性（Reader 1，58%；Reader 2，67%）或混合溶骨性成骨性（Reader 1，42%；Reader 2，34%）。没有单独的 CT 特征与生存相关。Reader 1 和 2 分别将 26%和 5%的患者判断为疾病改善，11%和 21%的患者为无变化，63%和 74%的患者为恶化，两名读者的一致性为 64%。整体 CT 评估与前列腺特异性抗原水平的变化百分比无相关性。对于经验更丰富的读者（Reader 2），改善或无变化的疾病患者的中位生存期显著延长（p=0.036）。
在 PCa 骨转移中，整体 CT 治疗后评估的读者间一致性较低，个别 CT 特征的差异很大。经验丰富的读者识别出的改善或稳定的疾病与更长的生存时间具有统计学相关性。
