1 Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
2 Department of Radiology, Teikyo University School of Medicine, Tokyo, Japan.
AJR Am J Roentgenol. 2018 May;210(5):W196-W204. doi: 10.2214/AJR.17.18814. Epub 2018 Apr 9.
The objective of this study was to investigate the incidence and clinical significance of intratumoral fat deposition in colorectal liver metastases (CLMs) after preoperative chemotherapy using dual-echo gradient-recalled echo MRI.
Our institutional review board approved this retrospective radiographic study and waived the requirement for informed patient consent. Fifty-nine patients (33 men, 26 women; median age, 62 years old) who underwent preoperative MRI and curative hepatic resection for colorectal liver metastases after chemotherapy were selected. Twenty patients also underwent MRI before chemotherapy. On dual-echo gradient-recalled echo MR images, intratumoral fat deposition and fat signal fraction at the densest areas of fat deposition in colorectal liver metastases were evaluated. Predictors of overall survival and intratumoral fat deposition after chemotherapy were identified by multivariate analyses.
Before and after chemotherapy, 0 (0%) and 32 (54%) of the patients exhibited intratumoral fat deposition, respectively. Independent predictors of poor overall survival were presence of five or more CLMs (p < 0.001), fat signal fraction of 12% or more (p = 0.01), age of 65 years or older (p = 0.02), and tumor response classified as progressive or stable disease by the Response Evaluation Criteria in Solid Tumors 1.1 (p = 0.049). Predictors of tumor fat signal fraction being 12% or greater after chemotherapy were largest tumor size of 5 cm or more (p = 0.005), tumor calcification (p = 0.008), and history of cetuximab or panitumumab administration (p = 0.04).
CLMs after preoperative chemotherapy frequently exhibit intratumoral fat deposition.
本研究旨在使用双回波梯度回波 MRI 探讨术前化疗后结直肠肝转移瘤（CLM）内脂肪沉积的发生率及临床意义。
本回顾性影像学研究经机构审查委员会批准，且豁免了患者知情同意书的要求。共纳入 59 例（男 33 例，女 26 例；中位年龄 62 岁）接受术前 MRI 检查并在化疗后接受结直肠肝转移瘤根治性肝切除术的患者。其中 20 例患者还在化疗前接受了 MRI 检查。在双回波梯度回波 MR 图像上，评估结直肠肝转移瘤内最致密脂肪沉积区域的肿瘤内脂肪沉积和脂肪信号分数。采用多变量分析确定总体生存和化疗后肿瘤内脂肪沉积的预测因素。
化疗前后，分别有 0（0%）和 32（54%）例患者出现肿瘤内脂肪沉积。总生存期较差的独立预测因素为存在 5 个或更多 CLM（p＜0.001）、脂肪信号分数≥12%（p=0.01）、年龄≥65 岁（p=0.02）和实体瘤反应评价标准 1.1 分类为进展或稳定疾病（p=0.049）。化疗后肿瘤脂肪信号分数≥12%的预测因素为肿瘤最大直径≥5cm（p=0.005）、肿瘤钙化（p=0.008）和使用西妥昔单抗或帕尼单抗治疗（p=0.04）。
术前化疗后的 CLM 常出现肿瘤内脂肪沉积。
