Department of Digestive Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Gut. 2018 Jun;67(6):1095-1102. doi: 10.1136/gutjnl-2017-313786. Epub 2017 Oct 30.
The purpose was to validate the prognostic value of an early optimal morphological response on CT in patients treated with bevacizumab-containing chemotherapy for unresectable colorectal cancer liver metastases (CLM). It also evaluated the prognostic value of size-based criteria and the association of optimal morphological response with the receipt of bevacizumab.
141 patients treated first using bevacizumab and 142 patients from a randomised study evaluating the addition of bevacizumab to oxaliplatin-based chemotherapy were retrospectively analysed. Radiologists evaluated pretreatment and restaging CT scans using morphological response criteria. Responses were also assessed with size-based criteria: Response Evaluation Criteria in Solid Tumors (RECIST), early tumour shrinkage (ETS) and deepness of response (DpR). The ability of each criterion to predict progression-free survival (PFS), overall survival (OS) and postprogression survival (PPS) was determined using a univariate Cox proportional hazards model.
In both populations, median PFS was significantly longer for patients achieving an optimal morphological response (10.4 vs 6.8 months, p=0.03; and 8.3 vs 4.9 months, p<00001, respectively). Neither RECIST nor ETS responses were associated with a prolonged PFS. Median OS was longer for those with an optimal morphological response but only at second restaging in the first population (n=141, 20.8 vs 12.3 months, p=0.002). DpR but not optimal morphological response was associated with PPS. In the randomised study, an optimal morphological response was 6.2 times more likely among patients receiving bevacizumab (p<0.0001).
In patients with unresectable CLM, early morphological response may be a better predictor of PFS than size-based response. The addition of bevacizumab improves morphological response rate.
旨在验证贝伐珠单抗联合化疗治疗不可切除结直肠癌肝转移（CLM）患者中 CT 早期最佳形态学反应的预后价值。还评估了基于大小的标准的预后价值以及最佳形态学反应与贝伐珠单抗使用的相关性。
回顾性分析了 141 例首程接受贝伐珠单抗治疗的患者和 142 例接受贝伐珠单抗联合奥沙利铂化疗随机研究的患者。放射科医生使用形态学反应标准评估预处理和再分期 CT 扫描。还使用基于大小的标准（实体瘤反应评估标准（RECIST）、早期肿瘤退缩（ETS）和反应深度（DpR））评估反应。使用单变量 Cox 比例风险模型确定每个标准预测无进展生存期（PFS）、总生存期（OS）和进展后生存期（PPS）的能力。
在两个队列中，达到最佳形态学反应的患者的中位 PFS 明显更长（分别为 10.4 个月 vs 6.8 个月，p=0.03；8.3 个月 vs 4.9 个月，p<0.0001）。RECIST 和 ETS 反应均与 PFS 无延长相关。在最佳形态学反应组中，中位 OS 更长，但仅在第一个队列的第二次再分期中（n=141，20.8 个月 vs 12.3 个月，p=0.002）。DpR 但不是最佳形态学反应与 PPS 相关。在随机研究中，接受贝伐珠单抗治疗的患者中，最佳形态学反应的可能性高 6.2 倍（p<0.0001）。
在不可切除的 CLM 患者中，早期形态学反应可能比基于大小的反应更能预测 PFS。贝伐珠单抗的加入提高了形态学反应率。
