From the Department of Radiology, University of Mississippi Medical Center, 2500 N State St, Jackson, MS 39216.
Radiology. 2014 Feb;270(2):425-34. doi: 10.1148/radiol.13130776. Epub 2013 Oct 28.
To predict survival in patients with metastatic melanoma by evaluating a combination of serum lactate dehydrogenase (LDH) level and initial computed tomographic (CT) findings of tumor devascularization after antiangiogenic therapy.
Consent was waived for this institutional review board-approved, retrospective, secondary analysis. Forty-four patients with metastatic melanoma received bevacizumab therapy in a randomized prospective phase II trial. Target lesions on the initial posttherapy CT images were evaluated by using Response Evaluation Criteria in Solid Tumors, the Choi criteria, and Morphology, Attenuation, Size, and Structure (MASS) criteria. Cox proportional hazards models were used to assess the association of baseline clinical variables including serum LDH and imaging findings with progression-free and overall survival. The receiver operating characteristic curve with area under the curve (AUC) was used to evaluate accuracy.
In multivariate analysis, a high baseline serum LDH level was associated with decreased progression-free survival (hazard ratio = 1.29 for each increase of 100 IU/L; P = .002) and overall survival (hazard ratio = 1.44 for each increase of 100 IU/L; P = .001). Evaluation with MASS criteria of the first CT examination after therapy strongly predicted progression-free (P < .001) and overall (P < .001) survival. Baseline serum LDH level was moderately accurate for predicting progression-free survival at 9 months (AUC = 0.793) and overall survival at 18 months (AUC = 0.689). The combination of baseline serum LDH levels and evaluation with MASS criteria at the first CT examination after therapy had significantly higher accuracy for predicting progression-free survival at 9 months (AUC = 0.969) and overall survival at 18 months (AUC = 0.813) than did baseline serum LDH levels alone for prediction of progression-free survival (P = .020).
A combination of baseline serum LDH levels and evaluation with MASS criteria at the first CT examination after bevacizumab therapy had the highest accuracy for predicting survival in patients with metastatic melanoma.
通过评估抗血管生成治疗后血清乳酸脱氢酶（LDH）水平和肿瘤去血管化初始计算机断层扫描（CT）表现的组合，预测转移性黑色素瘤患者的生存情况。
本研究为机构审查委员会批准的回顾性二次分析，同意被豁免。44 例转移性黑色素瘤患者在一项随机前瞻性 II 期试验中接受贝伐珠单抗治疗。使用实体瘤反应评估标准、Choi 标准和形态、衰减、大小和结构（MASS）标准评估初始治疗后 CT 图像上的靶病灶。使用 Cox 比例风险模型评估包括血清 LDH 和影像学表现在内的基线临床变量与无进展生存期和总生存期的相关性。使用曲线下面积（AUC）的接收者操作特征曲线来评估准确性。
在多变量分析中，基线血清 LDH 水平升高与无进展生存期（每增加 100IU/L 的风险比为 1.29；P=.002）和总生存期（每增加 100IU/L 的风险比为 1.44；P=.001）降低相关。治疗后首次 CT 检查的 MASS 标准评估强烈预测无进展生存期（P <.001）和总生存期（P <.001）。基线血清 LDH 水平在预测 9 个月时的无进展生存期（AUC=0.793）和 18 个月时的总生存期（AUC=0.689）方面具有中等准确性。与基线血清 LDH 水平相比，治疗后首次 CT 检查时联合 MASS 标准评估对预测 9 个月时的无进展生存期（AUC=0.969）和 18 个月时的总生存期（AUC=0.813）的准确性显著更高（P=.020）。
贝伐珠单抗治疗后首次 CT 检查时的基线血清 LDH 水平与 MASS 标准评估的组合对预测转移性黑色素瘤患者的生存情况具有最高的准确性。
