预测接受联合靶向免疫治疗的晚期肝细胞癌患者的生存情况：容积成像参数的评估。
Predicting survival of patients with advanced hepatocellular carcinoma receiving combination targeted immunotherapy: an evaluation of volumetric imaging parameters.
机构信息
Russell H. Morgan Department of Radiology and Radiological Sciences, School of Medicine, Johns Hopkins University, 600 North Wolfe Street, MRI 143, Baltimore, MD, 21287, USA.
Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
出版信息
Abdom Radiol (NY). 2024 Aug;49(8):2595-2605. doi: 10.1007/s00261-024-04257-0. Epub 2024 Mar 28.
PURPOSE
To evaluate the potential of volumetric imaging in predicting survival of advanced hepatocellular carcinoma (HCC) patients receiving immunotherapy.
METHODS
Retrospective analysis included 40 patients with advanced HCC who received targeted immunotherapy. Baseline and follow-up contrast-enhanced abdominal computed tomography (CT) scans were analyzed. The largest tumor was chosen as the index lesion. Viable tumor volume (qViable) and percentage tumor viability (%Viability) were calculated. Response Evaluation Criteria in Solid Tumors (RECIST) and Tumor volume change after treatment (qRECIST) were measured. Associations with overall survival (OS) were assessed. Cox regression analysis assessed the association between variables and overall survival (OS). A new prognostic stratification system was attempted to categorize patients based on significant predictors of OS. Patients with a baseline %viability > 69% and %viability reduction ≥ 8% were classified as better prognosis. Patients were stratified into better, intermediate and worse prognosis groups based on baseline %viability > 69% and ≥ 8% %viability reduction (better prognosis); baseline %viability ≤ 69% and < 8% %viability reduction (worse prognosis); remainder were intermediate prognosis.
RESULTS
Patients with baseline %Viability > 69% and %Viability reduction ≥ 8% showed significantly higher OS. Multivariate analysis confirmed %Viability and %Viability reduction as significant predictors of OS. A prognostic stratification system using these parameters stratified patients into better, intermediate and worse prognosis groups, with the better prognosis showing highest OS. Most patients (97.5%) had stable disease by RECIST while the prognostic model re-classified 47.5% as better prognosis, 37.5% intermediate prognosis, and 15% worse prognosis.
CONCLUSION
Volumetric parameters of %Viability and %Viability reduction predict OS in HCC patients undergoing immunotherapy.
目的
评估容积成像在预测接受免疫治疗的晚期肝细胞癌（HCC）患者生存中的潜力。
方法
回顾性分析包括 40 例接受靶向免疫治疗的晚期 HCC 患者。分析基线和随访增强腹部 CT 扫描。选择最大肿瘤作为指标病变。计算存活肿瘤体积（qViable）和肿瘤活力百分比（%Viability）。采用实体瘤反应评价标准（RECIST）和治疗后肿瘤体积变化（qRECIST）进行测量。评估与总生存期（OS）的相关性。Cox 回归分析评估变量与总生存期（OS）的相关性。尝试建立一种新的预后分层系统，根据 OS 的显著预测因素对患者进行分类。将基线 %viability>69%和 %viability 降低≥8%的患者归类为预后较好。根据基线 %viability>69%和≥8%的 %viability 降低（较好的预后）；基线 %viability≤69%和 <8%的 %viability 降低（较差的预后）；其余为中间预后，将患者分为较好、中间和较差预后组。
结果
基线 %Viability>69%和 %Viability 降低≥8%的患者 OS 显著提高。多变量分析证实 %Viability 和 %Viability 降低是 OS 的显著预测因素。使用这些参数的预后分层系统将患者分为较好、中间和较差预后组，较好预后组 OS 最高。大多数患者（97.5%）按 RECIST 标准为疾病稳定，而预测模型重新分类 47.5%为较好预后，37.5%为中间预后，15%为较差预后。
结论
%Viability 和 %Viability 降低的容积参数可预测接受免疫治疗的 HCC 患者的 OS。
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