Department of Urology, University Hospital, LMU Munich, Munich, Germany.
Radiologie Muenchen, Munich, Germany.
Urol Oncol. 2022 Jan;40(1):13.e1-13.e8. doi: 10.1016/j.urolonc.2021.08.012. Epub 2021 Sep 14.
To evaluate the role of dynamic contrast-enhanced CT (DCE-CT) as an independent non-invasive biomarker in predicting long term outcome in patients with metastatic renal cell carcinoma (mRCC) on antiangiogenic treatment.
Eighty two mRCC patients were prospectively enrolled from 09/2011 to 04/2015, out of which 71 were included in the final data analysis; the population was observed until 12/2020 to obtain complete overall survival data. DCE-CT imaging was performed at baseline and 10 to 12 weeks after start of treatment with targeted therapy. DCE-CT included a dynamic acquisition after injection of 50 ml of nonionic contrast agent at 6 ml/s using a 4D spiral mode (10 cm z-axis coverage, acquisition time 43 sec, 100 kVp (abdomen), 80 kVp (chest), 80-100 mAs) on a dual source scanner (Definition FLASH, Siemens). Blood flow (BF) was calculated for target tumor volumes using a deconvolution model. Progression free survival (PFS) and overall survival (OS) were analyzed using Kaplan-Meier statistics (SPSS version 24).
Patients were treated with either sunitinib, pazopanib, sorafenib, tivozanib, axitinib, or cabozantinib. A cut-off value of 50% blood flow reduction at follow-up allowed for identification of patients with favorable long-term outcome: Median OS in n = 42 patients with an average blood flow reduction of >50% (mean, 79%) was 34 (range, 14-54) months, while n = 21 patients with an average reduction of less than 50% (mean, 28%) showed a median OS of 12 (range, 6-18) months, and n = 8 patients with an increase in blood flow survived for a median of 7 (range, 3-11) months.
Blood flow in metastases measured with DCE-CT at first follow-up is a strong predictor of overall survival in mRCC patients on antiangiogenic treatment.
评估动态对比增强 CT（DCE-CT）作为独立的无创生物标志物在预测接受抗血管生成治疗的转移性肾细胞癌（mRCC）患者长期预后中的作用。
2011 年 9 月至 2015 年 4 月前瞻性纳入 82 例 mRCC 患者，其中 71 例纳入最终数据分析；该人群观察至 2020 年 12 月以获得完整的总生存数据。DCE-CT 成像在靶向治疗开始后 10-12 周进行，在注射 50ml 非离子型造影剂后进行动态采集，以 6ml/s 的速度采用 4D 螺旋模式（10cm z 轴覆盖范围，采集时间 43 秒，100kVp（腹部），80kVp（胸部），80-100mAs）在双源扫描仪（Definition FLASH，西门子）上进行。使用解卷积模型计算靶肿瘤体积的血流量（BF）。使用 Kaplan-Meier 统计（SPSS 版本 24）分析无进展生存期（PFS）和总生存期（OS）。
患者接受舒尼替尼、帕唑帕尼、索拉非尼、替沃扎尼、阿昔替尼或卡博替尼治疗。在随访中，将血流量减少 50%作为识别长期预后良好患者的截断值：42 例平均血流量减少＞50%（平均 79%）患者的中位 OS 为 34 个月（范围 14-54 个月），而 21 例平均减少低于 50%（平均 28%）患者的中位 OS 为 12 个月（范围 6-18 个月），8 例血流量增加患者的中位生存期为 7 个月（范围 3-11 个月）。
在接受抗血管生成治疗的 mRCC 患者中，DCE-CT 测量的转移部位血流量是总生存的强有力预测因子。
