Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiology, Peking University Cancer Hospital and Institute, Hai Dian District, Beijing, 100142, China.
Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Hepatopancreatobiliary Surgery Department I, Peking University Cancer Hospital and Institute, Hai Dian District, Beijing, 100142, China.
Ann Surg Oncol. 2022 Jun;29(6):3938-3949. doi: 10.1245/s10434-021-11101-y. Epub 2022 Jan 11.
Response Evaluation Criteria in Solid Tumors (RECIST) criteria are widely used for evaluating the therapeutic effect of colorectal liver metastases (CRLM) patients, but showed undesirable accuracy.
This study aimed to evaluate the value of functional MRI compared with RECIST criteria in predicting the therapeutic effect in CRLM patients receiving neoadjuvant chemotherapy with and without bevacizumab.
Overall, 137 patients with CRLM who received neoadjuvant chemotherapy followed by hepatic resection between January 2013 and November 2018 were included and were divided into the bevacizumab and non-bevacizumab groups. Apparent diffusion coefficient (ADC) values of pre- and post-treatment diffusion-weighted imaging (DWI) were generated on the whole-volume (ADC), periphery (ADC), and isocenter (ADC) of the tumor at the maximum slice. Overall survival (OS) and relapse-free survival (RFS) were used as prognostic indicators.
Post-treatment ADC was significantly associated with OS (p = 0.001) and RFS (p = 0.008) in the bevacizumab group, while RECIST-defined response was found to be only significantly associated with RFS in the non-bevacizumab group (p = 0.042). When categorizing the bevacizumab group by the post-treatment ADC cut-off value of 1.15 ×10 mm/s, patients in the ADC response group showed significantly better OS than the non-response group (3-year OS: 91.5% vs. 64.5%, p = 0.001). However, no significant difference was found between RECIST-defined response and non-response in either OS (3-year OS: 60.2% vs. 44.0%, p = 0.104) or RFS (3-year RFS: 26.2% vs. 17.4%, p = 0.129) in the bevacizumab group.
DWI-related parameters such as post-treatment ADC could accurately reflect the therapeutic effectiveness and predicting survival in patients treated with bevacizumab, which is superior to the RECIST criteria.
实体瘤反应评价标准（RECIST）广泛用于评估结直肠癌肝转移（CRLM）患者的治疗效果，但准确性不理想。
本研究旨在评估功能磁共振成像（fMRI）与 RECIST 标准相比，在预测接受贝伐珠单抗联合或不联合新辅助化疗的 CRLM 患者治疗效果方面的价值。
2013 年 1 月至 2018 年 11 月，共纳入 137 例接受新辅助化疗后行肝切除术的 CRLM 患者，分为贝伐珠单抗组和非贝伐珠单抗组。在最大层面上，对治疗前后扩散加权成像（DWI）的整个肿瘤体积（ADC）、肿瘤外周（ADC）和肿瘤中心（ADC）进行表观扩散系数（ADC）值的生成。总生存（OS）和无复发生存（RFS）作为预后指标。
贝伐珠单抗组中，治疗后 ADC 与 OS（p=0.001）和 RFS（p=0.008）显著相关，而非贝伐珠单抗组中 RECIST 定义的反应仅与 RFS 显著相关（p=0.042）。根据治疗后 ADC 截断值 1.15×10 mm/s 将贝伐珠单抗组进行分类，ADC 反应组的 OS 明显优于非反应组（3 年 OS：91.5% vs. 64.5%，p=0.001）。然而，在贝伐珠单抗组中，RECIST 定义的反应与非反应在 OS（3 年 OS：60.2% vs. 44.0%，p=0.104）或 RFS（3 年 RFS：26.2% vs. 17.4%，p=0.129）方面均无显著差异。
DWI 相关参数（如治疗后 ADC）可准确反映贝伐珠单抗治疗患者的治疗效果和生存预测，优于 RECIST 标准。
