基于 CT 增强图像的分形分析预测舒尼替尼治疗肝细胞癌患者的生存情况。
Fractal analysis of contrast-enhanced CT images to predict survival of patients with hepatocellular carcinoma treated with sunitinib.
机构信息
Division of Abdominal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, White 270, Boston, MA, 02114, USA,
出版信息
Dig Dis Sci. 2014 Aug;59(8):1996-2003. doi: 10.1007/s10620-014-3064-z. Epub 2014 Feb 22.
BACKGROUND
Intratumoral heterogeneity is a well-recognized feature of malignancy.
AIMS
To assess the heterogeneity of tumor using fractal analysis of contrast-enhanced computed tomography (CE-CT) images for predicting survival of hepatocellular carcinoma (HCC) patients treated with sunitinib.
METHODS
The patient cohort comprised 23 patients (19 men, 4 women; mean age 61.5 years) with HCC who underwent CE-CT at baseline and after one cycle of sunitinib. Arterial-phase (AP) and portal-phase (PP) CE-CT images were analyzed using a plugin software for ImageJ (NIH, Bethesda, MD). A differential box-counting method was employed to calculate the fractal dimension (FD) of the tumor. Tumor FD, density, and size were compared with survival.
RESULTS
Median progression-free survival (PFS) was 4.43 months. Patients were grouped into a favorable PFS (PFS >4.43 months; 9 patients) and an unfavorable PFS group (PFS ≤ 4.43; 13 patients). The baseline FD on both the AP and PP images was lower in the favorable PFS group than in the unfavorable PFS group (both P = 0.03). There was a significant difference in the change of the FD on the AP image between the favorable and unfavorable PFS groups (P = 0.02). Tumor density and size showed no significant correlations with PFS. In the Kaplan-Meier analysis, patients with tumors showing lower FD on the AP image at baseline showed longer PFS (P = 0.002). Patients with tumors showing a greater reduction in the FD on the PP image after one cycle of the therapy showed longer overall survival (P = 0.002).
CONCLUSION
The FD of the tumor on CE-CT images may be a useful biomarker for HCC patients treated with sunitinib.
背景
肿瘤内异质性是恶性肿瘤的一个公认特征。
目的
使用增强 CT （CE-CT）图像的分形分析评估肿瘤的异质性，以预测接受舒尼替尼治疗的肝细胞癌（HCC）患者的生存情况。
方法
本患者队列包括 23 名 HCC 患者（19 名男性，4 名女性；平均年龄 61.5 岁），他们在基线和舒尼替尼治疗一个周期后进行了 CE-CT。使用 ImageJ（NIH，贝塞斯达，MD）的插件软件分析动脉期（AP）和门静脉期（PP）CE-CT 图像。采用差分盒计数法计算肿瘤的分形维数（FD）。比较肿瘤 FD、密度和大小与生存的关系。
结果
中位无进展生存期（PFS）为 4.43 个月。患者分为预后良好的 PFS 组（PFS >4.43 个月；9 例）和预后不良的 PFS 组（PFS ≤ 4.43 个月；13 例）。在 AP 和 PP 图像上，预后良好的 PFS 组的基线 FD 均低于预后不良的 PFS 组（均 P = 0.03）。在 AP 图像上，预后良好的 PFS 组和预后不良的 PFS 组的 FD 变化有显著差异（P = 0.02）。肿瘤密度和大小与 PFS 无显著相关性。在 Kaplan-Meier 分析中，基线时 AP 图像上 FD 较低的患者 PFS 较长（P = 0.002）。治疗一个周期后 PP 图像上 FD 降低幅度较大的患者总生存期较长（P = 0.002）。
结论
CE-CT 图像上肿瘤的 FD 可能是接受舒尼替尼治疗的 HCC 患者的一个有用的生物标志物。
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