Tang Wenfang, Hou Qingyi, Lin Juntao, Li Dongjiang, Lin Jieshan, Chen Jinghua, Qiu Zhenbin, Chu Xiangpeng, Yang Xiongwen, Yan Honghong, Wang Shuxia, Wu Yilong, Zhong Wenzhao
Department of Cardiothoracic Surgery, Zhongshan People's Hospital, Zhongshan, China.
Guangdong Provincial Key Laboratory of Translational Medicine in Lung Cancer, Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
Front Oncol. 2020 Sep 2;10:1503. doi: 10.3389/fonc.2020.01503. eCollection 2020.
Response Evaluation Criteria in Solid Tumors (RECIST) is occasionally insufficient for evaluation. We proposed a new prognostic index (NPI) that combines the standardized uptake value (SUV), metabolic tumor volume (MTV), and RECIST. In total, 116 patients with lung cancer who underwent consecutive positron emission tomography-computed tomography prior to and after the initial treatment were included. We formulated the NPI by estimating the hazard ratios of overall survival for ΔMTV, ΔSUV, and ΔD (tumor size based on RECIST). Progression-free survival (PFS) and overall survival (OS) were compared between RECIST and the NPI. ROC curve analysis identified two cutoff values based on the NPI (≤ -49.3% and ≥43.4%) to discriminate partial remission (NPR), stable disease (NSD) and progressive disease (NPD). Based on RECIST, survival analysis did not discriminate significantly on either PFS or OS between the PR, SD, and PD groups. However, according to the NPI, PFS and OS differed significantly between the NPR, NSD, and NPD groups (training set: PFS, = 0.048; OS, = 0.026; validation set: PFS, = 0.004; OS, = 0.023). Moreover, therapeutic response based on NPI was independent prognostic factor for both PFS [NPR as reference, NSD: hazard ratio (HR) 2.04; 95% confidence interval (95% CI) 1.35-3.08; = 0.001; NPD: HR 6.87; 95% CI 3.03-15.57; < 0.001] and OS (NPR as reference, NSD: HR 1.64; 95% CI 1.05-2.57; = 0.031; NPD: HR 3.56; 95% CI 1.59-7.95; = 0.002). The NPI showed superiority for evaluation of the therapeutic response and survival for patients with non-small cell lung cancer, overcoming the limitations of RECIST.
实体瘤疗效评价标准（RECIST）偶尔不足以进行评估。我们提出了一种新的预后指数（NPI），它结合了标准化摄取值（SUV）、代谢肿瘤体积（MTV）和RECIST。总共纳入了116例在初始治疗前后连续接受正电子发射断层扫描-计算机断层扫描的肺癌患者。我们通过估计ΔMTV、ΔSUV和ΔD（基于RECIST的肿瘤大小）的总生存风险比来制定NPI。比较了RECIST和NPI之间的无进展生存期（PFS）和总生存期（OS）。ROC曲线分析基于NPI确定了两个临界值（≤ -49.3%和≥43.4%），以区分部分缓解（NPR）、疾病稳定（NSD）和疾病进展（NPD）。基于RECIST，生存分析在PR、SD和PD组之间的PFS或OS上均未显示出显著差异。然而，根据NPI，NPR、NSD和NPD组之间的PFS和OS存在显著差异（训练集：PFS，= 0.048；OS，= 0.026；验证集：PFS，= 0.004；OS，= 0.023）。此外，基于NPI的治疗反应是PFS [以NPR为参照，NSD：风险比（HR）2.04；95%置信区间（95%CI）1.35 - 3.08；= 0.001；NPD：HR 6.87；95%CI 3.03 - 15.57；< 0.001]和OS（以NPR为参照，NSD：HR 1.64；95%CI 1.05 - 2.57；= 0.031；NPD：HR 3.56；95%CI 1.59 - 7.95；= 0.002）的独立预后因素。NPI在评估非小细胞肺癌患者的治疗反应和生存方面显示出优越性，克服了RECIST的局限性。
