FDG-PET和CT显示不可切除复发性恶性胸膜间皮瘤患者对免疫检查点抑制剂治疗的反应
Response to Immune Checkpoint Inhibitor Therapy in Patients with Unresectable Recurrent Malignant Pleural Mesothelioma Shown by FDG-PET and CT.
作者信息
Kitajima Kazuhiro, Maruyama Mitsunari, Yokoyama Hiroyuki, Minami Toshiyuki, Yokoi Takashi, Nakamura Akifumi, Hashimoto Masaki, Kondo Nobuyuki, Kuribayashi Kozo, Kijima Takashi, Hasegawa Seiki, Yamakado Koichiro
机构信息
Department of Radiology, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya 663-8501, Japan.
Department of Internal Medicine, Division of Respiratory Medicine, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya 663-8501, Japan.
出版信息
Cancers (Basel). 2021 Mar 4;13(5):1098. doi: 10.3390/cancers13051098.
BACKGROUND
To compare three FDG-PET criteria (EORTC, PERCIST, imPERCIST) with CT criteria (combined modified RECIST and RECIST 1.1) for response evaluation and prognosis prediction in patients with recurrent MPM treated with ICI monotherapy.
METHODS
Thirty MPM patients underwent FDG-PET/CT and contrast-enhanced CT at the baseline and during nivolumab therapy (median 10 cycles). Therapeutic response was evaluated according to EORTC, PERCIST, imPERCIST, and CT criteria. PFS and OS were examined using log-rank and Cox methods.
RESULTS
CMR/PMR/SMD/PMD numbered 5/3/4/18 for EORTC, 5/1/7/17 for PERCIST, and 5/3/9/13 for imPERCIST. With CT, CR/PR/SD/PD numbered 0/6/10/14. There was high concordance between EORTC and PERCIST (κ = 0.911), and PERCIST and imPERCIST (κ = 0.826), while that between EORTC and imPERCIST (κ = 0.746) was substantial, and between CT and the three PET criteria moderate (κ = 0.516-0.544). After median 14.9 months, 26 patients showed progression and nine died. According to both PET and CT findings, patients with no progression (CMR/PMR/SMD or CR/PR/SD) showed significantly longer PFS and somewhat longer OS than PMD and PD patients (EORTC = 0.0004 and = 0.055, respectively; PERCIST = 0.0003 and = 0.052; imPERCIST < 0.0001 and = 0.089; CT criteria = 0.0015 and = 0.056).
CONCLUSIONS
Both FDG-PET and CT criteria are accurate for response evaluation of ICI therapy and prediction of MPM prognosis. In comparison with CT, all three FDG-PET/CT criteria judged a greater percentage of patients (16.7%) as CMR, while two (EORTC, PERCIST) judged a greater percentage (10-13.3%) as PMD. For predicting PFS, the three FDG-PET criteria were superior to the CT criteria, and imPERCIST demonstrated the highest rate of accurate prediction.
背景
比较三种氟代脱氧葡萄糖正电子发射断层扫描（FDG-PET）标准（欧洲癌症研究与治疗组织（EORTC）、实体瘤疗效评价标准（PERCIST）、改良实体瘤疗效评价标准（imPERCIST））与计算机断层扫描（CT）标准（联合改良实体瘤疗效评价标准和实体瘤疗效评价标准1.1），用于接受免疫检查点抑制剂（ICI）单药治疗的复发性恶性胸膜间皮瘤（MPM）患者的疗效评估和预后预测。
方法
30例MPM患者在基线期和纳武单抗治疗期间（中位10个周期）接受了FDG-PET/CT和增强CT检查。根据EORTC、PERCIST、imPERCIST和CT标准评估治疗反应。使用对数秩检验和Cox方法检查无进展生存期（PFS）和总生存期（OS）。
结果
EORTC标准下完全缓解（CMR）/部分缓解（PMR）/疾病稳定（SMD）/疾病进展（PMD）的病例数分别为5/3/4/18；PERCIST标准下分别为5/1/7/17；imPERCIST标准下分别为5/3/9/13。CT标准下，完全缓解（CR）/部分缓解（PR）/疾病稳定（SD）/疾病进展（PD）的病例数分别为0/6/10/14。EORTC与PERCIST之间一致性较高（κ = 0.911），PERCIST与imPERCIST之间一致性较高（κ = 0.826），EORTC与imPERCIST之间一致性较强（κ = 0.746），CT与三种PET标准之间一致性中等（κ = 0.516 - 0.544）。中位14.9个月后，26例患者出现疾病进展，9例死亡。根据PET和CT结果，无疾病进展（CMR/PMR/SMD或CR/PR/SD）的患者的PFS显著长于PMD和PD患者，OS也略长于PMD和PD患者（EORTC标准下PFS的P值 = 0.0004，OS的P值 = 0.055；PERCIST标准下PFS的P值 = 0.0003，OS的P值 = 0.052；imPERCIST标准下PFS的P值 < 0.0001，OS的P值 = 0.089；CT标准下PFS的P值 = 0.0015，OS的P值 = 0.056）。
结论
FDG-PET和CT标准对于ICI治疗的疗效评估和MPM预后预测均准确。与CT相比，所有三种FDG-PET/CT标准将更高比例（16.7%）的患者判定为CMR，而两种标准（EORTC、PERCIST）将更高比例（10 - 13.3%）的患者判定为PMD。对于预测PFS，三种FDG-PET标准优于CT标准，且imPERCIST显示出最高的准确预测率。
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