Yip Connie, Tacelli Nunzia, Remy-Jardin Martine, Scherpereel Arnaud, Cortot Alexis, Lafitte Jean-Jacques, Wallyn Frederic, Remy Jacques, Bassett Paul, Siddique Musib, Cook Gary J R, Landau David B, Goh Vicky
*Division of Imaging Sciences and Biomedical Engineering, King's College London Departments of #Clinical Oncology **Radiology, Guy's & St Thomas' NHS Foundation Trust, London ¶Statsconsultancy Ltd, Buckinghamshire, United Kingdom †Department of Radiation Oncology, National Cancer Centre, Singapore, Singapore ‡Department of Thoracic Imaging, Hospital Calmette §Faculty of Medicine, Henri Warembourg ∥Department of Pulmonary and Thoracic Oncology, University of Lille Nord de France, Lille, France.
J Thorac Imaging. 2015 Sep;30(5):300-7. doi: 10.1097/RTI.0000000000000164.
We aimed to assess computed tomography (CT) intratumoral heterogeneity changes, and compared the prognostic ability of the Response Evaluation Criteria in Solid Tumors (RECIST) 1.1, an alternate response method (Crabb), and CT heterogeneity in non-small cell lung cancer treated with chemotherapy with and without bevacizumab.
Forty patients treated with chemotherapy (group C) or chemotherapy and bevacizumab (group BC) underwent contrast-enhanced CT at baseline and after 1, 3, and 6 cycles of chemotherapy. Radiologic response was assessed using RECIST 1.1 and an alternate method. CT heterogeneity analysis generating global and locoregional parameters depicting tumor image spatial intensity characteristics was performed. Heterogeneity parameters between the 2 groups were compared using the Mann-Whitney U test. Associations between heterogeneity parameters and radiologic response with overall survival were assessed using Cox regression.
Global and locoregional heterogeneity parameters changed with treatment, with increased tumor heterogeneity in group BC. Entropy [group C: median -0.2% (interquartile range -2.2, 1.7) vs. group BC: 0.7% (-0.7, 3.5), P=0.10] and busyness [-27.7% (-62.2, -5.0) vs. -11.5% (-29.1, 92.4), P=0.10] showed a greater reduction in group C, whereas uniformity [1.9% (-8.0, 9.8) vs. -5.0% (-13.9, 5.6), P=0.10] showed a relative increase after 1 cycle but did not reach statistical significance. Two (9%) and 1 (6%) additional responders were identified using the alternate method compared with RECIST in group C and group BC, respectively. Heterogeneity parameters were not significant prognostic factors.
The alternate response method described by Crabb identified more responders compared with RECIST. However, both criteria and baseline imaging heterogeneity parameters were not prognostic of survival.
我们旨在评估计算机断层扫描（CT）肿瘤内异质性的变化，并比较实体瘤疗效评价标准（RECIST）1.1、一种替代反应方法（Crabb）以及CT异质性在接受化疗联合或不联合贝伐单抗治疗的非小细胞肺癌中的预后评估能力。
40例接受化疗的患者（C组）或接受化疗联合贝伐单抗的患者（BC组）在基线期以及化疗1、3和6周期后接受了增强CT检查。使用RECIST 1.1和一种替代方法评估影像学反应。进行了CT异质性分析，生成描述肿瘤图像空间强度特征的全局和局部参数。使用Mann-Whitney U检验比较两组之间的异质性参数。使用Cox回归评估异质性参数与影像学反应及总生存之间的关联。
全局和局部异质性参数随治疗而变化，BC组肿瘤异质性增加。熵[C组：中位数-0.2%（四分位间距-2.2，1.7）vs. BC组：0.7%（-0.7，3.5），P = 0.10]和繁忙度[-27.7%（-62.2，-5.0）vs. -11.5%（-29.1，92.4），P = 0.10]在C组中降低幅度更大，而均匀度[1.9%（-8.0，9.8）vs. -5.0%（-13.9，5.6），P = 0.10]在1周期后相对增加，但未达到统计学意义。与RECIST相比，使用替代方法在C组和BC组中分别额外识别出2例（9%）和1例（6%）反应者。异质性参数不是显著的预后因素。
与RECIST相比，Crabb描述的替代反应方法识别出更多反应者。然而，这两种标准以及基线影像学异质性参数均不能预测生存。
