Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, PR China.
Department of Colorectal Surgery, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong 510060, PR China.
Eur J Radiol. 2023 Aug;165:110950. doi: 10.1016/j.ejrad.2023.110950. Epub 2023 Jun 25.
Total tumor volume (TTV) may play an essential role in the estimation of tumor burden. This study is aimed to investigate the clinical value of the reduction ratio of TTV as a valuable indicator of clinical outcomes in patients with colorectal liver metastases (CRLM).
A total of 240 initially unresectable CRLM patients who underwent first-line systemic treatment were enrolled in this study. TTV at baseline and at the end of first-line treatment were assessed using a three-dimensional reconstruction system according to CT or MRI images. Survival was evaluated using Kaplan-Meier analysis and compared using Cox proportional hazard ratios (HR).
A total of 212 (88.3%) patients achieved tumor regression with a median reduction ratio of TTV of 86.0%. An increasing reduction ratio of TTV was associated with a gradually ascending successful conversion outcome. Patients with a reduction ratio >86.0% had better survival than those with a reduction ratio 0-86.0% or <0 (5-year overall survival (OS) rates, 64.4% vs. 44.9% vs. 23.5%, P < 0.001; 5-year progression-free survival (PFS) rates, 36.3% vs. 28.2% vs. 6.5%, P < 0.001). Multivariate analysis indicated that the reduction ratio of TTV ≤ 86.0% (OR [95%CI]: 4.956 [2.654-9.253], P < 0.001) was an independent factor for conversion failure outcome. Cox analyses revealed that the reduction ratio of TTV ≤ 86.0% was an independent factor for both unfavorable OS (HR [95%CI]: 2.216 [1.332-3.688], P = 0.002) and PFS (HR [95%CI]: 2.023 [1.376-2.974], P < 0.001).
The reduction ratio of TTV was an effective indicator for conversion outcome and long-term prognosis in patients with initially unresectable CRLM after first-line systemic treatment.
肿瘤总体积（TTV）可能在评估肿瘤负荷方面发挥重要作用。本研究旨在探讨 TTV 减少率作为结直肠癌肝转移（CRLM）患者临床结局的有价值指标的临床价值。
本研究共纳入 240 例最初不可切除的 CRLM 患者，这些患者接受了一线系统治疗。根据 CT 或 MRI 图像，使用三维重建系统评估基线和一线治疗结束时的 TTV。使用 Kaplan-Meier 分析评估生存情况，并使用 Cox 比例风险比（HR）进行比较。
共有 212（88.3%）例患者实现肿瘤消退，TTV 中位数减少率为 86.0%。TTV 减少率的增加与成功转化率的逐渐升高相关。减少率>86.0%的患者比减少率为 0-86.0%或<0 的患者具有更好的生存（5 年总生存率（OS）率分别为 64.4%、44.9%和 23.5%，P<0.001；5 年无进展生存率（PFS）率分别为 36.3%、28.2%和 6.5%，P<0.001）。多变量分析表明，TTV 减少率≤86.0%（OR [95%CI]：4.956 [2.654-9.253]，P<0.001）是转化率失败的独立因素。Cox 分析表明，TTV 减少率≤86.0%是 OS （HR [95%CI]：2.216 [1.332-3.688]，P=0.002）和 PFS （HR [95%CI]：2.023 [1.376-2.974]，P<0.001）均不良的独立因素。
TTV 减少率是一线系统治疗后最初不可切除的 CRLM 患者转化结局和长期预后的有效指标。
