Hayano Koichi, Kulkarni Naveen M, Duda Dan G, Heist Rebecca Suk, Sahani Dushyant V
1 Division of Abdominal Imaging and Intervention, Massachusetts General Hospital, 55 Fruit St, White 270, Boston, MA 02114.
2 Steele Laboratory, Massachusetts General Hospital, Boston, MA.
AJR Am J Roentgenol. 2016 May;206(5):987-93. doi: 10.2214/AJR.15.15528. Epub 2016 Mar 2.
The objective of this study was to compare imaging biomarkers, including (18)F-FDG PET, CT perfusion (CTP), and CT texture analysis (CTTA), in predicting the survival of patients with advanced non-small cell lung cancer (NSCLC) treated with antiangiogenic chemotherapy.
A total of 35 patients (17 men and 18 women; median age, 64.0 years) with advanced NSCLC treated with antiangiogenic chemotherapy were evaluated. CTP and FDG PET were performed before the therapy, and blood flow, blood volume, mean transit time, and the maximum standardized uptake value (SUV max) of the tumor were measured. Texture parameters, including the mean value of pixels with positive values (MPP) and entropy (a measure of irregularity), were also measured on pretherapeutic unenhanced CT images, using CTTA software with a medium texture scale filtration. The best percent change in the tumor burden was also measured. These image-derived tumor parameters were then compared with progression-free survival (PFS) and overall survival (OS).
In univariate Cox regression analysis, MPP and entropy were significantly correlated with PFS (p = 0.01 and p = 0.01, respectively), whereas SUV max, MPP, and entropy were significantly correlated with OS (p = 0.03, p = 0.04, and p = 0.0008, respectively). In Kaplan-Meier analysis, high MPP and low entropy were significantly associated with favorable PFS (p < 0.0001 and p = 0.03, respectively) and OS (p = 0.0009 and p = 0.005, respectively), and low SUV max was significantly associated with favorable OS (p = 0.01). CTP parameters and the best change in the tumor burden had no associations with survival. In multivariate analysis, only entropy was identified as an independent prognostic factor for OS (p = 0.02).
CTTA is the optimal imaging biomarker for predicting the survival of patients with advanced NSCLC treated with antiangiogenic chemotherapy.
本研究旨在比较包括（18）F-FDG PET、CT灌注（CTP）和CT纹理分析（CTTA）在内的成像生物标志物，以预测接受抗血管生成化疗的晚期非小细胞肺癌（NSCLC）患者的生存期。
共评估了35例接受抗血管生成化疗的晚期NSCLC患者（17例男性和18例女性；中位年龄64.0岁）。在治疗前进行CTP和FDG PET检查，测量肿瘤的血流、血容量、平均通过时间和最大标准化摄取值（SUV max）。还使用具有中等纹理尺度过滤的CTTA软件，在治疗前的平扫CT图像上测量纹理参数，包括正值像素的平均值（MPP）和熵（不规则度的一种度量）。同时测量肿瘤负荷的最佳百分比变化。然后将这些图像衍生的肿瘤参数与无进展生存期（PFS）和总生存期（OS）进行比较。
在单因素Cox回归分析中，MPP和熵与PFS显著相关（分别为p = 0.01和p = 0.01），而SUV max、MPP和熵与OS显著相关（分别为p = 0.03、p = 0.04和p = 0.0008）。在Kaplan-Meier分析中，高MPP和低熵与良好的PFS（分别为p < 0.0001和p = 0.03）和OS（分别为p = 0.0009和p = 0.005）显著相关，低SUV max与良好的OS显著相关（p = 0.01）。CTP参数和肿瘤负荷的最佳变化与生存期无关。在多因素分析中，仅熵被确定为OS的独立预后因素（p = 0.02）。
CTTA是预测接受抗血管生成化疗的晚期NSCLC患者生存期的最佳成像生物标志物。
