Kanemura Shingo, Kuribayashi Kozo, Funaguchi Norihiko, Shibata Eisuke, Mikami Koji, Doi Hiroshi, Kitajima Kazuhiro, Hasegawa Seiki, Nakano Takashi
Department of Respiratory Medicine, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo 663-8501, Japan.
Department of Respiratory Medicine, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo 663-8501, Japan.
Eur J Radiol. 2017 Jan;86:92-98. doi: 10.1016/j.ejrad.2016.11.009. Epub 2016 Nov 5.
Efficient monitoring of tumor responsiveness to chemotherapy is essential to mitigate high mortality risks and cytotoxic effects of chemotherapeutics. However, there is no consensus on the most suitable diagnostic technique/parameters for assessing response to chemotherapy in malignant pleural mesothelioma (MPM). We compared the tumor responsiveness of MPM patients as assessed using modified RECIST (mRECIST) criteria and integrated 18F-FDG-PET/CT.
Histologically confirmed MPM patients (N=82) who were treated with three cycles of cisplatin and pemetrexed, or carboplatin and pemetrexed, were included. mRECIST and integrated 18F-FDG-PET/CT were used to evaluate MPM tumor response to chemotherapy. Metabolic non-responders were defined as those with a 25% or greater increase in SUVmax compared with the previous value. Time to progression (TTP) and overall survival (OS) were compared between metabolic-responders and non-responders.
After three cycles of chemotherapy, 62(75.6%) of the patients were classified as having SD, 15 (18%) with partial remission (PR), and 5 (6%) with progressive disease (PD), based on mRECIST criteria. The cumulative median OS was 728.0days (95% confidence interval [CI]: 545.9-910.1) and cumulative median TTP was 365.0days (95% CI: 296.9-433.1). For the 82 patients, the disease control rate was 93.9%, whereas the metabolic response rate was only 71.9% (p<0.001). All PD and PR patients were found to be metabolic responders on 18F-FDG-PET/CT; however, among the 62mRECIST SD patients, 18 (29%) were classified as metabolic non-responders. The median TTP for metabolic responders was 13.7 months, while it was 10.0 months for non-responders(p<0.001). Metabolic responders had a trend toward longer OS, although the difference did not reach statistical significance (metabolic responders:33.9 months; non-responders: 21.6 months; p>0.05).
Several mRECIST-confirmed SD MPM patients may be classified as metabolic non-responders on18F-FDGPET/CT. Metabolic response is significantly correlated with the median TTP, suggesting it should be included in the evaluation of the response to chemotherapy in MPM patients classified as mRECIST SD, to identify non-responders.
有效监测肿瘤对化疗的反应对于降低化疗带来的高死亡风险和细胞毒性作用至关重要。然而，对于评估恶性胸膜间皮瘤（MPM）化疗反应的最合适诊断技术/参数尚无共识。我们比较了使用改良RECIST（mRECIST）标准和综合18F-FDG-PET/CT评估的MPM患者的肿瘤反应性。
纳入经组织学确诊、接受了三个周期顺铂和培美曲塞或卡铂和培美曲塞治疗的MPM患者（N = 82）。使用mRECIST和综合18F-FDG-PET/CT评估MPM肿瘤对化疗的反应。代谢无反应者定义为SUVmax较前值增加25%或更多的患者。比较代谢反应者和无反应者的进展时间（TTP）和总生存期（OS）。
根据mRECIST标准，三个周期化疗后，62例（75.6%）患者被分类为疾病稳定（SD），15例（18%）部分缓解（PR），5例（6%）疾病进展（PD）。累积中位OS为728.0天（95%置信区间[CI]：545.9 - 910.1），累积中位TTP为365.0天（95% CI：296.9 - 433.1）。对于这82例患者，疾病控制率为93.9%，而代谢反应率仅为71.9%（p<0.001）。所有PD和PR患者在18F-FDG-PET/CT上均为代谢反应者；然而，在62例mRECIST SD患者中，18例（29%）被分类为代谢无反应者。代谢反应者的中位TTP为13.7个月，无反应者为10.0个月（p<0.001）。代谢反应者的OS有延长趋势，尽管差异未达到统计学意义（代谢反应者：33.9个月；无反应者：21.6个月；p>0.05）。
一些mRECIST确认的SD MPM患者在18F-FDG-PET/CT上可能被分类为代谢无反应者。代谢反应与中位TTP显著相关，表明在评估被分类为mRECIST SD的MPM患者的化疗反应时应纳入代谢反应，以识别无反应者。
