动态对比增强超声在预测实体瘤抗血管生成治疗结局中的验证：法国多中心对创新及昂贵技术的支持研究
Validation of dynamic contrast-enhanced ultrasound in predicting outcomes of antiangiogenic therapy for solid tumors: the French multicenter support for innovative and expensive techniques study.
作者信息
Lassau Nathalie, Bonastre Julia, Kind Michèle, Vilgrain Valérie, Lacroix Joëlle, Cuinet Marie, Taieb Sophie, Aziza Richard, Sarran Antony, Labbe-Devilliers Catherine, Gallix Benoit, Lucidarme Olivier, Ptak Yvette, Rocher Laurence, Caquot Louis-Michel, Chagnon Sophie, Marion Denis, Luciani Alain, Feutray Sylvaine, Uzan-Augui Joëlle, Coiffier Benedicte, Benastou Baya, Koscielny Serge
机构信息
From the *Integrated Research Cancer Institute, Research Department, Villejuif; †Service Biostatistique et Épidémiologie, Gustave Roussy, Villejuif; ‡Imaging Department, Institut Bergonié, Bordeaux; §Department of Radiology, Assistance Publique-Hôpitaux de Paris, Hôpital Beaujon, Clichy, and Université Paris Diderot, Sorbonne Paris Cité; ∥Department of Radiology, Centre François Baclesse, Caen; ¶Department of Radiology, Centre Léon Bérard, Lyon; #Imaging Department, Centre Oscar Lambret, Lille; **Radiodiagnostics Department, Centre Claudius Regaud, Toulouse; ††Imaging Department, Institut Paoli Calmettes, Marseille; ‡‡Radiodiagnostics Department, Centre R Gauducheau, Institut de Cancérologie de l'Ouest Nantes; §§Department of Abdominal and Digestive Imaging, Hôpital Saint-Éloi, Montpellier; ∥∥Radiology Department, Centre Hospitalier Universitaire La Pitié-Salpêtrière, Paris; ¶¶Radiodiagnostics Department, Centre Jean Perrin, Clermont-Ferrand; ##Radiology Department, Centre Hospitalier Universitaire Bicêtre, Le Kremlin-Bicêtre; ***Radiodiagnostics and Imaging Department, Institut Jean Godinot, Reims; †††Ultrasonography Department, Hôpital Ambroise Paré, Boulogne-Billancourt; ‡‡‡Radiology Department, Centre Hospitalier Universitaire Hôtel-Dieu, Lyon; §§§Radiology Department, Centre Hospitalier Universitaire Henri Mondor, Créteil; ∥∥∥Imaging Department, Centre Georges-François Leclerc, Dijon Cedex; and ¶¶¶Radiology Department, Hôpital Cochin, Paris, France.
出版信息
Invest Radiol. 2014 Dec;49(12):794-800. doi: 10.1097/RLI.0000000000000085.
OBJECTIVES
Dynamic contrast-enhanced ultrasound (DCE-US) has been used in single-center studies to evaluate tumor response to antiangiogenic treatments: the change of area under the perfusion curve (AUC), a criterion linked to blood volume, was consistently correlated with the Response Evaluation Criteria in Solid Tumors response. The main objective here was to do a multicentric validation of the use of DCE-US to evaluate tumor response in different solid tumor types treated by several antiangiogenic agents. A secondary objective was to evaluate the costs of the procedure.
MATERIALS AND METHODS
This prospective study included patients from 2007 to 2010 in 19 centers (8 teaching hospitals and 11 comprehensive cancer centers). All patients treated with antiangiogenic therapy were eligible. Dynamic contrast-enhanced ultrasound examinations were performed at baseline as well as on days 7, 15, 30, and 60. For each examination, a perfusion curve was recorded during 3 minutes after injection of a contrast agent. Change from baseline at each time point was estimated for each of 7 fitted criteria. The main end point was freedom from progression (FFP). Criterion/time-point combinations with the strongest correlation with FFP were analyzed further to estimate an optimal cutoff point.
RESULTS
A total of 1968 DCE-US examinations in 539 patients were analyzed. The median follow-up was 1.65 years. Variations from baseline were significant at day 30 for several criteria, with AUC having the most significant association with FFP (P = 0.00002). Patients with a greater than 40% decrease in AUC at day 30 had better FFP (P = 0.005) and overall survival (P = 0.05). The mean cost of each DCE-US was 180&OV0556;, which corresponds to $250 using the current exchange rate.
CONCLUSIONS
Dynamic contrast-enhanced ultrasound is a new functional imaging technique that provides a validated criterion, namely, the change of AUC from baseline to day 30, which is predictive of tumor progression in a large multicenter cohort. Because of its low cost, it should be considered in the routine evaluation of solid tumors treated with antiangiogenic therapy.
目的
动态对比增强超声（DCE-US）已用于单中心研究，以评估肿瘤对抗血管生成治疗的反应：灌注曲线下面积（AUC）的变化与血容量相关，该指标始终与实体瘤疗效评价标准中的反应相关。本研究的主要目的是对DCE-US用于评估多种抗血管生成药物治疗的不同实体瘤类型的肿瘤反应进行多中心验证。次要目的是评估该检查的成本。
材料与方法
这项前瞻性研究纳入了2007年至2010年期间来自19个中心（8家教学医院和11家综合癌症中心）的患者。所有接受抗血管生成治疗的患者均符合条件。在基线以及第7、15、30和60天进行动态对比增强超声检查。每次检查时，在注射造影剂后的3分钟内记录灌注曲线。对7个拟合标准中的每一个，估计每个时间点相对于基线的变化。主要终点是无进展生存期（FFP）。进一步分析与FFP相关性最强的标准/时间点组合，以估计最佳截止点。
结果
共分析了539例患者的1968次DCE-US检查。中位随访时间为1.65年。在第30天，几个标准相对于基线的变化具有显著性，其中AUC与FFP的相关性最为显著（P = 0.00002）。第30天AUC下降超过40%的患者具有更好的FFP（P = 0.005）和总生存期（P = 0.05）。每次DCE-US的平均成本为180欧元，按照当前汇率相当于250美元。
结论
动态对比增强超声是一种新的功能成像技术，它提供了一个经过验证的标准，即从基线到第30天AUC的变化，这在一个大型多中心队列中可预测肿瘤进展。由于其成本较低，在对抗血管生成治疗的实体瘤进行常规评估时应予以考虑。
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