Departments of Radiology.
Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston MA.
J Thorac Imaging. 2020 Mar;35(2):101-107. doi: 10.1097/RTI.0000000000000413.
Targeted inhibition of anaplastic lymphoma kinase (ALK) has been widely used for the treatment of advanced non-small cell lung cancer (NSCLC) with ALK rearrangements. We performed tumor volume analysis of ALK-rearranged advanced NSCLC treated with crizotinib to identify an early predictive marker for prolonged survival.
Cases of 42 patients with ALK-rearranged advanced NSCLC (16 men, 26 women; median age: 55.7 y) treated with crizotinib as their first ALK-directed therapy were retrospectively studied. Tumor volume measurements of dominant lung lesions were performed on baseline computed tomography and follow-up computed tomography at 8 weeks of therapy. The relationships between the 8-week volume change (%) and overall survival (OS) were investigated.
The 8-week tumor volume change ranged from -99.3% to 117.5% (median: -57.7%). Using the 25th percentile of the 8-week volume change of -74%, 11 patients with >74% volume decrease at 8 weeks had a significantly longer OS compared with 31 patients with ≤74% decrease (median OS: 92.0 vs. 22.8 mo; P=0.0048). In multivariable analyses using Cox proportional hazards models, the 8-week volume decrease of >74% was significantly associated with longer OS (hazard ratio=0.14, 95% confidence interval: 0.03-0.59; Cox P=0.008) after adjusting for tumor stage (stage IV vs. recurrent NSCLC, hazard ratio=5.6, 95% confidence interval: 1.29-24.3; P=0.02).
The 8-week tumor volume decrease of >74% is significantly associated with longer OS in patients with ALK-rearranged NSCLC treated with crizotinib.
针对间变性淋巴瘤激酶（ALK）的靶向抑制已被广泛用于治疗具有 ALK 重排的晚期非小细胞肺癌（NSCLC）。我们对接受克唑替尼治疗的 ALK 重排的晚期 NSCLC 患者进行肿瘤体积分析，以确定延长生存的早期预测标志物。
回顾性研究了 42 例接受克唑替尼作为一线 ALK 靶向治疗的 ALK 重排的晚期 NSCLC 患者（男性 16 例，女性 26 例；中位年龄：55.7 岁）。在基线 CT 和治疗 8 周的随访 CT 上对主要肺病变的肿瘤体积进行测量。研究了 8 周体积变化（%）与总生存期（OS）之间的关系。
8 周肿瘤体积变化范围为-99.3%至 117.5%（中位数：-57.7%）。使用 8 周体积变化的第 25 百分位数-74%，8 周时体积减少>74%的 11 例患者的 OS 明显长于体积减少≤74%的 31 例患者（中位 OS：92.0 与 22.8 个月；P=0.0048）。使用 Cox 比例风险模型的多变量分析，在调整肿瘤分期（IV 期与复发性 NSCLC，风险比=5.6，95%置信区间：1.29-24.3；P=0.02）后，8 周时体积减少>74%与 OS 延长显著相关（风险比=0.14，95%置信区间：0.03-0.59；Cox P=0.008）。
接受克唑替尼治疗的 ALK 重排 NSCLC 患者，8 周肿瘤体积减少>74%与 OS 延长显著相关。
