针对激光消融治疗脑转移瘤中进展性疾病定义的研究：一项基于证据的研究。
Towards the definition of progressive disease in brain metastasis treated with laser ablation: an evidence-based study.
机构信息
Department of Neurological Surgery, University of Miami Miller School of Medicine, Lois Pope Life Center, 1095 NW 14th Terrace 2nd Floor, (D4-6), Miami, FL, 33136, USA.
Department of Neurosurgery, University of California, San Francisco, School of Medicine, 533 Parnassus Ave, San Francisco, CA, 94143, USA.
出版信息
J Neurooncol. 2023 Jun;163(2):463-471. doi: 10.1007/s11060-023-04360-0. Epub 2023 Jun 12.
PURPOSE
The postoperative period after laser interstitial thermal therapy (LITT) is marked by a temporary increase in volume, which can impact the accuracy of radiographic assessment. The current criteria for progressive disease (PD) suggest that a 20% increase in size of brain metastasis (BM) assessed in 6-12 weeks intervals should be considered as local progression (LP). However, there is no agreement on how LP should be defined in this context. In this study, we aimed to statistically analyze which tumor volume variations were associated with LP.
METHODS
We analyzed 40 BM that underwent LITT between 2013 and 2022. For this study, LP was defined following radiographic features. A ROC curve was generated to evaluate volume change as a predictor of LP and find the optimal cutoff point. A logistic regression analysis and Kaplan Meier curves were performed to assess the impact of various clinical variables on LP.
RESULTS
Out of 40 lesions, 12 (30%) had LP. An increase in volume of 25.6% from baseline within 120-180 days after LITT presented a 70% sensitivity and 88.9% specificity for predicting LP (AUC: 0.78, p = 0.041). The multivariate analysis showed a 25% increase in volume between 120 and 180 days as a negative predictive factor (p = 0.02). Volumetric changes within 60-90 days after LITT did not predict LP (AUC: 0.57; p = 0.61).
CONCLUSION
Volume changes within the first 120 days after the procedure are not independent indicators of LP of metastatic brain lesions treated with LITT.
目的
激光间质热疗（LITT）后的术后阶段，体积会出现暂时增加，这可能会影响放射学评估的准确性。目前，对于进展性疾病（PD）的标准建议，如果在 6-12 周的时间间隔内评估脑转移瘤（BM）的大小增加了 20%，应将其视为局部进展（LP）。然而，对于这种情况下如何定义 LP，尚未达成共识。在这项研究中，我们旨在通过统计学分析，确定哪些肿瘤体积变化与 LP 相关。
方法
我们分析了 2013 年至 2022 年间接受 LITT 治疗的 40 个 BM。在这项研究中，LP 是根据放射学特征来定义的。生成 ROC 曲线以评估体积变化作为 LP 的预测指标，并找到最佳截断点。进行逻辑回归分析和 Kaplan-Meier 曲线分析，以评估各种临床变量对 LP 的影响。
结果
在 40 个病灶中，有 12 个（30%）出现 LP。在 LITT 后 120-180 天内，体积增加 25.6%，对预测 LP 的灵敏度为 70%，特异性为 88.9%（AUC：0.78，p=0.041）。多变量分析显示，在 120-180 天之间，体积增加 25%是 LP 的阴性预测因素（p=0.02）。LITT 后 60-90 天内的体积变化不能预测 LP（AUC：0.57；p=0.61）。
结论
在接受 LITT 治疗的转移性脑病变的术后 120 天内，体积变化不是 LP 的独立指标。
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