肺容积测量作为恶性胸膜间皮瘤患者反应的替代标志物。
Lung volume measurements as a surrogate marker for patient response in malignant pleural mesothelioma.
机构信息
Department of Radiology, The University of Chicago, Chicago, IL 60637, USA.
出版信息
J Thorac Oncol. 2013 Apr;8(4):478-86. doi: 10.1097/JTO.0b013e31828354c8.
INTRODUCTION
The purpose of this study was to investigate the continuous changes in three distinct response assessment methods during treatment as a marker of response for patients with mesothelioma. Linear tumor thickness measurements, disease volume measurements, and lung volume measurements (a physiological correlate of disease volumes) were investigated in this study.
METHODS
Serial computed tomography scans were obtained during the course of clinically standard chemotherapy for 61 patients. For each of the 216 computed tomography scans, the aerated lung volumes were segmented using a fully automated method, and the pleural disease volume was segmented using a semiautomated method. Modified Response Evaluation Criteria in Solid Tumors linear-thickness measurements were acquired clinically. Diseased (ipsilateral) lung volumes were normalized by the respective contralateral lung volumes to account for the differences in inspiration between scans for each patient. Relative changes in each metric from baseline were tracked over the course of follow-up imaging. Survival modeling was performed using Cox proportional hazards models with time-varying covariates.
RESULTS
Median survival from pretreatment baseline imaging was 12.7 months. A negative correlation was observed between measurements of lung volume and disease volume, and a positive correlation was observed between linear-thickness measurements and disease volume. As continuous numerical parameters, all three response assessment methods were significant imaging biomarkers of patient prognosis in independent survival models.
CONCLUSIONS
Analysis of trajectories of linear-thickness measurements, disease volume measurements, and lung volume measurements during chemotherapy for patients with mesothelioma indicates that increasing linear thickness, increasing disease volume, and decreasing lung volume are all significantly and independently associated with poor patient prognosis.
简介
本研究旨在探讨三种不同反应评估方法在治疗过程中的连续变化，作为间皮瘤患者反应的标志物。本研究中研究了线性肿瘤厚度测量、疾病体积测量和肺体积测量（疾病体积的生理相关物）。
方法
对 61 名患者接受临床标准化疗过程中的连续计算机断层扫描进行了研究。对于每 216 次计算机断层扫描，使用全自动方法对充气肺体积进行分割，并使用半自动方法对胸膜疾病体积进行分割。使用实体瘤反应评估标准的改良线性厚度测量值进行临床采集。为了说明每次扫描之间吸气的差异，将患病（同侧）肺体积除以相应的对侧肺体积进行归一化。从基线开始，跟踪每种指标在随访成像过程中的变化。使用带有时变协变量的 Cox 比例风险模型进行生存建模。
结果
从预处理基线成像开始的中位生存时间为 12.7 个月。观察到肺体积和疾病体积之间存在负相关，线性厚度测量值和疾病体积之间存在正相关。作为连续的数值参数，三种反应评估方法在独立的生存模型中都是患者预后的重要影像学标志物。
结论
对间皮瘤患者化疗期间线性厚度测量值、疾病体积测量值和肺体积测量值的轨迹进行分析表明，线性厚度增加、疾病体积增加和肺体积减少均与患者预后不良显著相关。
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