Classification of Neoadjuvant Therapy Response in Patients With Colorectal Liver Metastases Using Contrast-Enhanced Ultrasound—With Histological Pathology as the Gold Standard

IF 2.4 3区医学 Q2 ACOUSTICS

Ultrasound in Medicine and Biology Pub Date : 2024-10-15 DOI:10.1016/j.ultrasmedbio.2024.09.013

Li Liu , Wen-Chao Cui , Yu Sun , Hong Wang , Zi-Nan Liang , Wei Wu , Kun Yan , Yong-Li Ji , Liang Dong , Wei Yang

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引用次数: 0

Abstract

Objective

To evaluate the response to neoadjuvant therapy in patients with colorectal liver metastases (CRLMs) using ultrasound(US) and contrast-enhanced ultrasound(CEUS), with correction to the tumor regression grade (TRG) of pathological results.

Methods

This study included patients with resectable CRLMs admitted from February to December 2022. After at least 4 cycles neoadjuvant therapy, all the patients received US and CEUS examinations within two weeks before hepatectomy. CEUS clips were postprocessed with color parameter imaging (CPI) and microflow imaging (MFI) analysis. Logistic regression analyses were used to develop an evaluation Nomogram. Ultrasound-based model was constructed to discriminate between the response (TRG1/2/3) and nonresponse (TRG4/5) groups at the lesion level. The model's predictive ability was evaluated using the C index and calibration curve, with decision curve analysis assessing the Nomogram's added value.

Results

The study analyzed 105 CRLM lesions (the lesion with the highest diameter analyzed for each patient), with 43.8% showing a response to therapy. Univariate analysis identified calcification on US (p = 0.039), CEUS enhancement degree (p < 0.001), CEUS enhancement pattern (p<0.001), CEUS washout type (p < 0.001), CEUS necrosis (p < 0.001), CPI feeding artery (p = 0.003) and MFI pattern (p < 0.001) were significantly associated with TRG. The multivariate analysis showed CEUS enhancement pattern (p = 0.026), CEUS washout type (p = 0.018) and CEUS necrosis (p = 0.005) were independently associated with the neoadjuvant therapy response. A Nomogram with the three independent predictors was developed, with an AUC of 0.898.

Conclusion

The ultrasound-based model provided accurate evaluation of pathological tumor response to preoperative chemotherapy in patients with CRLM, and may help to decide the individualized treatment strategy.

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利用对比增强超声对结直肠肝转移患者的新辅助治疗反应进行分类--以组织学病理学为金标准

目的使用超声（US）和对比增强超声（CEUS）评估结直肠肝转移瘤（CRLMs）患者对新辅助治疗的反应，并对病理结果的肿瘤回归分级（TRG）进行校正：研究对象包括2022年2月至12月收治的可切除CRLM患者。经过至少4个周期的新辅助治疗后，所有患者均在肝切除术前两周内接受了US和CEUS检查。CEUS 片段经彩色参数成像（CPI）和微流成像（MFI）分析进行后处理。使用逻辑回归分析制定了评估提名图。构建了基于超声的模型，用于在病变水平上区分有反应组（TRG1/2/3）和无反应组（TRG4/5）。利用 C 指数和校准曲线评估了模型的预测能力，并通过决策曲线分析评估了 Nomogram 的附加值：研究分析了105个CRLM病变（分析了每位患者直径最大的病变），43.8%的病变对治疗有反应。单变量分析确定了 US 上的钙化（p = 0.039）、CEUS 增强程度（p < 0.001）、CEUS 增强模式（pConclusion）：基于超声的模型能准确评估CRLM患者的病理肿瘤对术前化疗的反应，有助于决定个体化治疗策略。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Ultrasound in Medicine and Biology 医学-核医学

CiteScore

6.20

自引率

6.90%

发文量

325

审稿时长

70 days

期刊介绍： Ultrasound in Medicine and Biology is the official journal of the World Federation for Ultrasound in Medicine and Biology. The journal publishes original contributions that demonstrate a novel application of an existing ultrasound technology in clinical diagnostic, interventional and therapeutic applications, new and improved clinical techniques, the physics, engineering and technology of ultrasound in medicine and biology, and the interactions between ultrasound and biological systems, including bioeffects. Papers that simply utilize standard diagnostic ultrasound as a measuring tool will be considered out of scope. Extended critical reviews of subjects of contemporary interest in the field are also published, in addition to occasional editorial articles, clinical and technical notes, book reviews, letters to the editor and a calendar of forthcoming meetings. It is the aim of the journal fully to meet the information and publication requirements of the clinicians, scientists, engineers and other professionals who constitute the biomedical ultrasonic community.