Suresh Krithika, Owen Dawn, Bazzi Latifa, Jackson William, Ten Haken Randall K, Cuneo Kyle, Feng Mary, Lawrence Theodore S, Schipper Matthew J
Department of Biostatistics, University of Michigan, Ann Arbor, Michigan.
Department of Biostatistics, University of Michigan, Ann Arbor, Michigan; Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan.
Int J Radiat Oncol Biol Phys. 2018 Jan 1;100(1):131-137. doi: 10.1016/j.ijrobp.2017.09.032. Epub 2017 Sep 22.
To test the hypothesis that mid-treatment measures of the retention of indocyanine green after 15 minutes (ICGR15) would improve the prediction of posttreatment liver function in the setting of hepatocellular carcinoma.
Between 2006 and 2015, 144 patients with hepatocellular carcinoma received 175 courses of stereotactic body radiation therapy (SBRT). Patient data, such as age, sex, portal vein thrombosis, cirrhosis, Child-Pugh (CP) score, prior liver-directed therapies, and liver function tests, including albumin-bilirubin (ALBI) and ICG clearance, and dosimetric data, such as tumor volume and radiation dose, were collected. Toxicity was evaluated as a 2-point increase in CP score or a change in ALBI score at 3 months from start of SBRT. Logistic or linear regression was used to build toxicity prediction models based on patient and tumor characteristics and ICG clearance variables. Performance of the models for the binary CP outcome was summarized using area under the curve and receive operating characteristic curves. Likelihood ratio tests were used to evaluate whether the model fit improved after incorporating the ICG variable information.
In multivariable analysis age, baseline ICGR15, and change in ICGR15 were associated with toxicity defined by increased CP score. For the continuous ALBI outcome, being female, having cirrhosis, and increasing radiation dose were associated with increased toxicity. When incorporating ICGR15 into these models, an increase in ICGR15 from baseline to mid-treatment was most consistently significantly associated with an increase in toxicity.
Incorporation of ICGR15 variables significantly improves the prediction of post-SBRT liver function. The use of ICGR15 can facilitate the delivery of the maximum safe dose of radiation for patients with hepatocellular carcinoma and has the potential to improve uncomplicated tumor control and survival.
检验以下假设：在肝细胞癌治疗过程中，15分钟吲哚菁绿滞留率（ICGR15）的中期测量值能够改善对治疗后肝功能的预测。
2006年至2015年期间，144例肝细胞癌患者接受了175个疗程的立体定向体部放射治疗（SBRT）。收集患者数据，如年龄、性别、门静脉血栓形成、肝硬化、Child-Pugh（CP）评分、既往肝脏定向治疗以及肝功能检查，包括白蛋白-胆红素（ALBI）和吲哚菁绿清除率，以及剂量学数据，如肿瘤体积和放射剂量。毒性评估为自SBRT开始3个月时CP评分增加2分或ALBI评分变化。使用逻辑回归或线性回归，基于患者和肿瘤特征以及吲哚菁绿清除率变量构建毒性预测模型。使用曲线下面积和受试者工作特征曲线总结二元CP结局模型的性能。使用似然比检验评估纳入吲哚菁绿变量信息后模型拟合是否改善。
在多变量分析中，年龄、基线ICGR15和ICGR15的变化与CP评分增加所定义的毒性相关。对于连续的ALBI结局，女性、患有肝硬化以及放射剂量增加与毒性增加相关。将ICGR15纳入这些模型时，从基线到治疗中期ICGR15的增加最一致且显著地与毒性增加相关。
纳入ICGR15变量显著改善了SBRT后肝功能的预测。使用ICGR15能够为肝细胞癌患者提供最大安全放射剂量，并且有可能改善无并发症的肿瘤控制和生存率。
