非小细胞肺癌 PD-1 阻断后早期不同反应标准的比较分析。
Comparative analysis of different response criteria at early phase after PD-1 blockade in non-small lung cancer.
机构信息
Department of Respiratory Medicine, International Medical Center, Saitama Medical University, 1397-1 Yamane, Hidaka-City, Saitama, 350-1298, Japan.
Department of Respiratory Medicine, Hidaka Hospital, 886, Nakao-cho, Takasaki, 370-0001, Japan.
出版信息
Cancer Imaging. 2023 Mar 1;23(1):23. doi: 10.1186/s40644-023-00538-x.
PURPOSE
To compare different response criteria using computed tomography (CT) and positron emission tomography (PET) in measuring response and survival in the early phase after programmed death-1 (PD-1) blockade monotherapy in patients with advanced non-small cell lung cancer (NSCLC).
METHODS
A total of 54 patients with advanced NSCLC who had 2-deoxy-2-[fluorine-18]-fluoro-D-glucose PET or CT at baseline, and 4 and 9 weeks after PD-1 blockade, were registered. Therapeutic response was assessed according to the Response Evaluation Criteria in Solid Tumors (RECIST), the immune-modified RECIST (irRECIST), the PET Response Criteria in Solid Tumors (PERCIST), the immune-modified PERCIST (iPERCIST), and the European Organization for Research and Treatment of Cancer (EORTC) criteria for dichotomous groups, such as responders vs. non-responders and controlled vs. uncontrolled diseases. Cohen's κ was used to evaluate the concordance among the different criteria.
RESULTS
The concordance between CT and PET response criteria was fair or slight for responders vs. non-responders, but the agreement between iPERCIST and irRECIST was moderate for controlled vs. uncontrolled diseases. The agreement between EORTC and PERCIST or iPERCIST in detecting responders was higher in the application of metabolic tumor volume (MTV) and total lesion glycolysis (TLG) than in the standardized uptake value corrected for lean body mass (SUL). To distinguish controlled from uncontrolled disease, RECIST, irRECIST, and PET criteria (PERCIST, iPERCIST, and EORTC) defined by MTV or TLG were found to be significant predictors of progression-free survival. To distinguish responders from non-responders, iPERCIST by SUL or EORTC by TLG were identified as significant indicators. The EORTC criteria using TLG for the detection of responders or uncontrolled diseases had a significantly higher predictive value for response assessment.
CONCLUSIONS
The EORTC criteria based on TLG for the early detection of responders and uncontrolled disease were effective as a response assessment at 4 weeks after the PD-1 blockade. When SUL was not used but MTV or TLG was, the agreement between EORTC and PERCIST or iPERCIST was almost perfect.
目的
比较程序性死亡受体-1（PD-1）单药阻断治疗晚期非小细胞肺癌（NSCLC）患者早期使用计算机断层扫描（CT）和正电子发射断层扫描（PET）测量应答和生存的不同应答标准。
方法
共登记了 54 例晚期 NSCLC 患者，基线时有 2-脱氧-2-[氟-18]-氟代-D-葡萄糖 PET 或 CT，以及 PD-1 阻断后 4 周和 9 周。根据实体瘤反应评估标准（RECIST）、免疫改良 RECIST（irRECIST）、实体瘤 PET 反应标准（PERCIST）、免疫改良 PERCIST（iPERCIST）和欧洲癌症研究与治疗组织（EORTC）对二项分组标准，如应答者与非应答者和控制与未控制疾病，评估治疗反应。采用 Cohen's κ 评价不同标准之间的一致性。
结果
CT 和 PET 应答标准在应答者与非应答者之间的一致性为中等或轻度，而在控制与未控制疾病之间，iPERCIST 和 irRECIST 的一致性为中度。在代谢肿瘤体积（MTV）和总病灶糖酵解（TLG）应用中，EORTC 与 PERCIST 或 iPERCIST 在检测应答者方面的一致性高于标准化摄取值校正瘦体质量（SUL）。为了区分控制与未控制疾病，发现 RECIST、irRECIST 和 PET 标准（PERCIST、iPERCIST 和 EORTC）以 MTV 或 TLG 定义是无进展生存的显著预测因子。为了区分应答者与非应答者，发现 SUL 中的 iPERCIST 或 TLG 中的 EORTC 是显著指标。EORTC 标准以 TLG 检测应答者或未控制疾病具有更高的预测价值。
结论
EORTC 标准基于 TLG 早期检测 PD-1 阻断后 4 周的应答者和未控制疾病，作为应答评估有效。当不使用 SUL 而使用 MTV 或 TLG 时，EORTC 与 PERCIST 或 iPERCIST 之间的一致性几乎是完美的。
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