Zhang Rui, Wang Zhi-Yu, Li Yue-Hua, Lu Yao-Hong, Wang Shuai, Yu Wen-Xi, Zhao Hui
Department of Internal Oncology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiaotong University Shanghai 200233, People's Republic of China.
Department of Radiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiaotong University Shanghai 200233, People's Republic of China.
Am J Cancer Res. 2016 Dec 1;6(12):2890-2900. eCollection 2016.
Metastatic bone disease is a frequent complication of advanced non-small cell lung cancer (NSCLC) and causes skeletal-related events, which result in a poor prognosis. Currently, no standard method has been developed to precisely assess the therapeutic response of bone metastases (BM) and the early efficacy of anti-angiogenic therapy, which does not conform to the concept of precision medicine. This study aimed to investigate the usefulness of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) for precise evaluation of the response to chemotherapy with anti-angiogenic agents in NSCLC patients with BM. Patients were randomly assigned to a treatment group (vinorelbine + cisplatin [NP] + recombinant human endostatin [rh-endostatin]) or a control group (NP + placebo). All patients were evaluated before treatment and after 2 cycles of treatment using DCE-MRI quantitative analysis technology for BM lesions and chest computed tomography (CT). Correlations between changes in the DCE-MRI quantitative parameters and treatment effect were analyzed. We enrolled 33 patients, of whom 28 were evaluable (20 in the treatment group and 8 in the control group). The results suggested a higher objective response rate (30% vs. 0%), better overall survival (21.44 ± 17.28 months vs. 7.71 ± 4.68 months), and a greater decrease in the transport constant (Ktrans) value (60% vs. 4.4%) in the treatment group than in the control group ( < 0.05). The Ktrans values in the "partial remission plus stable disease (PR + SD)" group were significantly lower after treatment ( < 0.05). Patients with a decrease of > 50% in the Ktrans value showed a significantly better overall survival than those with a decrease of ≤ 50% (13.2 vs. 9.8 months, < 0.05). Ktrans as a DEC-MRI quantitative parameter could be used for the precise evaluation of BM lesions after anti-angiogenic therapy and as a predictor of survival. In addition, we reconfirmed the anti-angiogenic effect of rh-endostatin in NSCLC patients with BM.
骨转移疾病是晚期非小细胞肺癌（NSCLC）的常见并发症，可导致骨相关事件，进而导致预后不良。目前，尚未开发出精确评估骨转移（BM）治疗反应及抗血管生成治疗早期疗效的标准方法，这不符合精准医学的理念。本研究旨在探讨动态对比增强磁共振成像（DCE-MRI）在精准评估NSCLC伴BM患者抗血管生成药物化疗反应中的应用价值。将患者随机分为治疗组（长春瑞滨+顺铂[NP]+重组人血管内皮抑素[rh-血管内皮抑素]）和对照组（NP+安慰剂）。所有患者在治疗前及治疗2个周期后，采用DCE-MRI定量分析技术对BM病灶及胸部计算机断层扫描（CT）进行评估。分析DCE-MRI定量参数变化与治疗效果之间的相关性。我们纳入了33例患者，其中28例可评估（治疗组20例，对照组8例）。结果显示，治疗组的客观缓解率更高（30% vs. 0%）、总生存期更好（21.44±17.28个月 vs. 7.71±4.68个月），且转运常数（Ktrans）值的下降幅度更大（60% vs. 4.4%），均优于对照组（P<0.05）。“部分缓解加病情稳定（PR+SD）”组治疗后的Ktrans值显著降低（P<0.05）。Ktrans值下降>50%的患者总生存期显著优于下降≤50%的患者（13.2 vs. 9.8个月，P<0.05）。Ktrans作为DCE-MRI定量参数可用于抗血管生成治疗后BM病灶的精准评估及生存预测。此外，我们再次证实了rh-血管内皮抑素在NSCLC伴BM患者中的抗血管生成作用。
