灌注磁共振成像作为索拉非尼治疗晚期肝细胞癌的生物标志物：一项初步研究。
Perfusion Magnetic Resonance as a Biomarker for Sorafenib-Treated Advanced Hepatocellular Carcinoma: A Pilot Study.
作者信息
Campos Marta, Candelária Isabel, Papanikolaou Nickolas, Simão Adélia, Ferreira Carlos, Manikis Georgios C, Caseiro-Alves Filipe
机构信息
Faculty of Medicine, Universidade de Coimbra, Coimbra, Portugal.
Medical Imaging Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
出版信息
GE Port J Gastroenterol. 2019 Jul;26(4):260-267. doi: 10.1159/000493351. Epub 2019 Feb 18.
BACKGROUND
Sorafenib is the currently recommended therapy in patients with advanced hepatocellular carcinoma (HCC). Among the several biomarkers available for the evaluation of the therapeutic response and prognosis, there is perfusion magnetic resonance imaging (p-MRI) that, through measurement of the vascular permeability unit (ktrans), may retrieve useful information regarding the microvascular properties of focal liver lesions. The aim of this study was to evaluate the impact of sorafenib therapy in patients with advanced HCC using the p-MRI technique.
MATERIALS AND METHODS
In this retrospective study, 27 patients with the diagnosis of advanced HCC were included for palliative therapy using sorafenib. MRI of the liver was performed before the beginning of the oral therapy (T0), after 3 (T3), and after 6 months (T6). Dynamic acquisitions of the tumor ( = 50, during the first 2 min after contrast injection) were obtained in the coronal plane and were used to compute the parametric perfusion maps, acquiring the ktrans value using the extended Tofts pharmacokinetic model.
RESULTS
The value of ktrans obtained at T0 was significantly different from the value of ktrans obtained at T6 ( = 0.028). There were no significant differences between T0 and T3 ( = 0.115) or a correlation between ktrans at T0 and the size of the lesion ( = 0.376). The ktrans value at T0 in patients with progression-free survival (PFS) > 6 months was not significantly different from the ktrans value in patients with PFS ≤6 months ( = 0.113). The ktrans value at T0 was not significantly different between patients who were previously submitted to chemoembolization and those who were not submitted ( = 0.587).
CONCLUSION
In this pilot study, the ktrans value may serve as a biomarker of tumor response to antiangiogenic therapy, but only 6 months after its initiation. Clinical outcomes such as PFS were not predicted before the initiation of treatment.
背景
索拉非尼是目前推荐用于晚期肝细胞癌（HCC）患者的治疗药物。在可用于评估治疗反应和预后的多种生物标志物中，有灌注磁共振成像（p-MRI），它通过测量血管通透性单位（ktrans），可以获取有关肝脏局灶性病变微血管特性的有用信息。本研究的目的是使用p-MRI技术评估索拉非尼治疗对晚期HCC患者的影响。
材料与方法
在这项回顾性研究中，纳入了27例诊断为晚期HCC并接受索拉非尼姑息治疗的患者。在口服治疗开始前（T0）、3个月后（T3）和6个月后（T6）进行肝脏MRI检查。在冠状面获取肿瘤的动态图像（在注射造影剂后的前2分钟内，n = 50），并用于计算参数灌注图，使用扩展的Tofts药代动力学模型获取ktrans值。
结果
T0时获得的ktrans值与T6时获得的ktrans值有显著差异（P = 0.028）。T0和T3之间无显著差异（P = 0.115），T0时的ktrans值与病变大小之间也无相关性（P = 0.376）。无进展生存期（PFS）> 6个月的患者T0时的ktrans值与PFS≤6个月的患者的ktrans值无显著差异（P = 0.113）。既往接受过化疗栓塞的患者与未接受过化疗栓塞的患者T0时的ktrans值无显著差异（P = 0.587）。
结论
在这项初步研究中，ktrans值可作为肿瘤对抗血管生成治疗反应的生物标志物，但仅在治疗开始6个月后。在治疗开始前无法预测诸如PFS等临床结局。
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