Department of Urology, JR Tokyo General Hospital, 2-3-1 Yoyogi Shibuya-ku, Tokyo, 151-8528, Japan.
Department of Urology, Jikei University School of Medicine, Tokyo, Japan.
Int J Clin Oncol. 2018 Jun;23(3):547-552. doi: 10.1007/s10147-017-1224-9. Epub 2017 Dec 18.
The aim of this study was to evaluate the influence of components of angiomyolipoma (AML) on the efficacy of everolimus.
We investigated a total of 40 patients with tuberous sclerosis complex (TSC) who had AML ≥4 cm in diameter. The components of the AML were determined using abdominal computed tomography (CT) images. The AML density was measured as the mean Hounsfield unit (HU) values of the whole area of the AML on axial CT images. We classified them into two groups, i.e., a lipid group with a predominant lipid component (HU ≤ -50) and a solid group with predominant vascular and muscle components (HU ≥30). For each patient, we measured the AML reduction rate and transition of the mean HU value.
The mean reduction rate of AML in the lipid group was 24%, whereas it was 68% in the solid group (P < 0.001). The mean tumor density after 6 months was decreased in both groups. In particular, the density significantly decreased compared to the baseline in the solid group (P < 0.001). The tumor density did not change after 6 months in either group.
The effect of everolimus on TSC-AML is mainly a reduction of the solid components consisting of angioma and leiomyoma. The tumor density at the start of treatment might be a predictive marker for the response to everolimus in TSC-AML.
本研究旨在评估血管平滑肌脂肪瘤(AML)成分对依维莫司疗效的影响。
我们共研究了 40 例直径≥4cm 的结节性硬化症(TSC)患者的 AML。使用腹部 CT 图像确定 AML 的成分。AML 密度通过轴向 CT 图像上 AML 整个区域的平均 Hounsfield 单位(HU)值来测量。我们将它们分为两组,即富含脂质成分(HU≤-50)的脂质组和富含血管和肌肉成分(HU≥30)的实体组。对于每个患者,我们测量 AML 的缩小率和平均 HU 值的变化。
脂质组 AML 的平均缩小率为 24%,而实体组为 68%(P<0.001)。两组的平均肿瘤密度在 6 个月后均降低。特别是在实体组,与基线相比,密度显著降低(P<0.001)。在治疗 6 个月后,两组的肿瘤密度均未发生变化。
依维莫司对 TSC-AML 的作用主要是减少由血管瘤和平滑肌瘤组成的实体成分。治疗开始时的肿瘤密度可能是 TSC-AML 对依维莫司反应的预测标志物。