Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands; Department of Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.
Department of Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.
Eur J Cancer. 2013 Jul;49(11):2486-93. doi: 10.1016/j.ejca.2013.03.027. Epub 2013 May 18.
In patients with colorectal liver metastases (CLM) there is limited knowledge about the occurrence of radiological heterogeneity in response to chemotherapy.
A retrospective analysis was performed in the CAIRO and CAIRO II studies on the incidence of intermetastatic heterogeneity in patients with CLM and its association with survival. Mixed response (MR) was defined as >30% difference in individual lesion response, with all lesions showing a similar behaviour; true mixed response (TMR) as two lesions showing progression versus response; homogeneous response (HR) as similar behaviour of all lesions. Patients were classified according to the Response Evaluation Criteria in Solid Tumours (RECIST) categories (partial response (PR), stable disease (SD), progressive disease (PD), complete response (CR)) and then subdivided into MR and TMR in order to compare survival.
In the CAIRO and CAIRO II studies, 140 and 150 patients with liver-only disease were identified. 73/290 (25.2%) patients showed MR, and 25/290 (8.6%) patients TMR, and 192/290 (66.2%) patients HR. Overall survival (OS) at 1-4 years was significantly higher for the homogeneous partial responders category compared to other response categories. Median OS was 22.0 months for the entire population. In the partial response category, patients with MR showed significant poorer survival compared to patients with HR (median OS 23.7 versus 36.0 months, respectively, p=0.019). Multivariate analysis identified four independent predictors for OS: serum lactate dehydrogenase (LDH) level (p=0.002), number of first-line chemotherapy cycles (p=0.001), resection of primary tumour (p=0.001) and response category (p=0.012).
Radiological heterogeneity is present in approximately 35% of patients with CLM. Partial responders according to the RECIST criteria, show a significant poorer survival if classified as heterogeneous partial responder compared to homogeneous partial responders.
在结直肠癌肝转移（CLM）患者中，对于化疗反应的影像学异质性的发生，人们知之甚少。
对 CAIRO 和 CAIRO II 研究中的 CLM 患者的肝内转移灶异质性发生率及其与生存的相关性进行回顾性分析。混合反应（MR）定义为个体病变反应差异>30%，所有病变表现出相似的行为；真正的混合反应（TMR）为两个病变表现为进展与反应；均一反应（HR）为所有病变表现出相似的行为。患者根据实体瘤反应评估标准（RECIST）分类（部分缓解（PR）、稳定疾病（SD）、进展性疾病（PD）、完全缓解（CR）），然后分为 MR 和 TMR，以比较生存情况。
在 CAIRO 和 CAIRO II 研究中，共确定了 140 例和 150 例仅有肝转移的患者。73/290（25.2%）例患者表现为 MR，25/290（8.6%）例患者为 TMR，192/290（66.2%）例患者为 HR。在 1-4 年内，均一性部分缓解患者的总体生存率（OS）显著高于其他反应类别。整个队列的中位 OS 为 22.0 个月。在部分缓解类别中，MR 患者的生存显著差于 HR 患者（中位 OS 分别为 23.7 个月和 36.0 个月，p=0.019）。多变量分析确定了 OS 的四个独立预测因素：血清乳酸脱氢酶（LDH）水平（p=0.002）、一线化疗周期数（p=0.001）、原发肿瘤切除术（p=0.001）和反应类别（p=0.012）。
大约 35%的 CLM 患者存在影像学异质性。根据 RECIST 标准，部分缓解患者如果被归类为异质性部分缓解者，与均一性部分缓解者相比，生存显著更差。
