INSERM U970, Paris, France.
Université Paris Descartes, Sorbonne Paris Cité, Paris, France.
Eur Radiol. 2019 Sep;29(9):5022-5031. doi: 10.1007/s00330-019-6007-4. Epub 2019 Feb 20.
To determine whether intraprocedural C-arm cone-beam CT (CBCT) parenchymal blood volume (PBV) can predict the response of colorectal cancer liver metastases (CRCLM) 2 months after irinotecan drug-eluting bead (DEBIRI) chemoembolization.
This single-center observational study was compliant with the Helsinki Declaration and approved by our institutional review board. Thirty-four consecutive CRCLM patients referred for DEBIRI chemoembolization were enrolled between March 2015 and December 2016. Tumor size was assessed at baseline and 2 months after DEBIRI chemoembolization by multidetector CT (Response Evaluation Criteria in Solid Tumors RECIST 1.0), and PBV was measured before and after DEBIRI chemoembolization. Two independent readers reviewed all data. We determined the potential correlation (Spearman's rank correlation) between intraprocedural PBV values and tumor response at 2 months. The relationship between tumor response and PBV was studied using a mixed model. A logistic regression model was applied to study the relationship between patient "Responder/Non-responder" and PBV.
There was a strong correlation between baseline PBV or the percent change of PBV and the 2-month tumor response (rho = - 0.8587 (p = 0.00001) and rho = 0.8027 (p = 0.00001), respectively). The mixed model showed that an increase of 1 ml/1000 ml in PBV of a tumor before DEBIRI chemoembolization led to a 0.54 mm decrease in diameter (p < 0.005). A 1% decrease in PBV after DEBIRI chemoembolization resulted in tumor shrinkage of 0.75 mm (p < 0.005). The logistic regression model showed that patients with a 1% smaller mean decrease of PBV after DEBIRI chemoembolization had a 10% lower likelihood of achieving disease control (OR = 0.9, 95% confidence interval (CI) = 0.81-1; p = 0.0493).
Intraprocedural PBV may predict tumor response to DEBIRI chemoembolization.
• There is a strong relationship between the parenchymal blood volume (PBV) of colorectal liver metastases before DEBIRI chemoembolization and tumor response at 2 months. • Higher PBV values before DEBIRI chemoembolization correlate with greater tumor shrinkage, but only if the PBV decreases by more than 70% after DEBIRI chemoembolization. • Each increase of 1% in the mean decrease of PBV after DEBIRI chemoembolization resulted in a 10% lower likelihood of achieving disease control (OR = 0.9, 95% confidence interval (CI) = 0.81-1; p = 0.0493).
确定术中 C 臂锥形束 CT（CBCT）实质血容量（PBV）是否可以预测伊立替康载药微球（DEBIRI）化疗栓塞后 2 个月结直肠癌肝转移（CRCLM）的反应。
这项单中心观察性研究符合赫尔辛基宣言，并得到了我们机构审查委员会的批准。2015 年 3 月至 2016 年 12 月，我们招募了 34 例连续的 CRCLM 患者，他们因 DEBIRI 化疗栓塞而接受治疗。在 DEBIRI 化疗栓塞前后，通过多排 CT（实体瘤反应评估标准 RECIST 1.0）评估肿瘤大小，并在 DEBIRI 化疗栓塞前后测量 PBV。两名独立的读者审查了所有数据。我们确定了术中 PBV 值与 2 个月时肿瘤反应之间的潜在相关性（Spearman 秩相关）。使用混合模型研究肿瘤反应与 PBV 之间的关系。应用逻辑回归模型研究患者“应答者/无应答者”与 PBV 之间的关系。
基线 PBV 或 PBV 变化百分比与 2 个月时的肿瘤反应之间存在很强的相关性（rho = -0.8587（p = 0.00001）和 rho = 0.8027（p = 0.00001））。混合模型显示，DEBIRI 化疗栓塞前肿瘤 PBV 增加 1ml/1000ml，直径减少 0.54mm（p < 0.005）。DEBIRI 化疗栓塞后 PBV 降低 1%，肿瘤缩小 0.75mm（p < 0.005）。逻辑回归模型显示，DEBIRI 化疗栓塞后 PBV 平均降低 1%的患者疾病控制的可能性降低 10%（OR = 0.9，95%置信区间（CI）= 0.81-1；p = 0.0493）。
术中 PBV 可能预测 DEBIRI 化疗栓塞后的肿瘤反应。
• DEBIRI 化疗栓塞前结直肠癌肝转移的实质血容量（PBV）与 2 个月时的肿瘤反应之间存在很强的关系。• DEBIRI 化疗栓塞前 PBV 值较高与肿瘤缩小相关，但前提是 DEBIRI 化疗栓塞后 PBV 降低超过 70%。• DEBIRI 化疗栓塞后 PBV 平均降低每增加 1%，疾病控制的可能性降低 10%（OR = 0.9，95%置信区间（CI）= 0.81-1；p = 0.0493）。
