The value of MSCT volume measurement in neoadjuvant chemotherapy for advanced gastric cancer

中华普通外科杂志 Pub Date : 2019-10-25 DOI:10.3760/CMA.J.ISSN.1007-631X.2019.10.004

Yang Liu, Qun Zhao, Yong Li, L. Fan, B. Tan, Zhidong Zhang, Dong Wang, Yu Liu, Honghai Guo, Peigang Yang, Yuan Tian

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Abstract

Objective To evaluate the efficacy of chemotherapy and estimate the prognosis of patients with progressive gastric cancer. Methods A total of 116 patients from a prospective, multicenter, open-label, and randomized phase Ⅲ clinical trial were enrolled in the Fourth Hospital of Hebei Medical University from Dec 2012 to Jun 2015. Pre- and two weeks after neoadjuvant chemotherapy, multi-slice spiral CT was performed to calculate the percentage change of the longest diameter and tumor volume to evaluate the Recist score and tumor volume reduction rate. Spearman correlation test was used to analyze the correlation of post-volume reduction rate, Recist 1.1 score, and tumor regression grade. The ROC curve was used to find a defined value for the volume reduction rate that identifies the effectiveness of chemotherapy and assign a new grading standard. The survival curve was drawn by Kaplan-Meier method, and the relationship between the effective survival group and the ineffective group under the new grading standard was observed. Results The Recist score was moderately correlated with the pathological tumor regression scale, and the volume reduction rate after chemotherapy was strongly correlated with the pathological regression scale (R=0.579). When the tumor volume reduction rate was 12.5% as an effective threshold for evaluating neoadjuvant chemotherapy, the AUC under the ROC curve was the largest, with sensitivity and specificity of 81.1% and 75.9%, respectively. The median survival time of the effective and ineffective groups was 25 months and 18 months, respectively, and the 2-year survival rate was 73.3% and 51.2%. The total survival time of patients with effective chemotherapy was significantly longer than those with ineffective chemotherapy (P=0.003 6). Conclusion The volume measurement grading standard can predict the pathological regression of neoadjuvant chemotherapy patients, and it is superior to the Recist score in the evaluation of efficacy and prognosis. Key words: Stomach neoplasms; Tomography, spiral computed; Chemoradiotherapy, adjuvant; Prognosis

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MSCT体积测量在癌症新辅助化疗中的价值

目的评价癌症进展期患者的化疗效果及预后。方法2012年12月至2015年6月，河北医科大学第四医院对116例患者进行了前瞻性、多中心、开放标签、随机Ⅲ期临床试验。新辅助化疗前和化疗后两周，进行多层螺旋CT，计算最长直径和肿瘤体积的百分比变化，以评估Recist评分和肿瘤体积缩小率。Spearman相关检验用于分析容积缩小率、Recist 1.1评分和肿瘤消退等级的相关性。ROC曲线用于确定容量减少率的定义值，以确定化疗的有效性并指定新的分级标准。采用Kaplan-Meier法绘制生存曲线，观察新分级标准下有效生存组与无效生存组的关系。结果Recist评分与病理性肿瘤回归量表呈中度相关，化疗后减容率与病理性回归量表呈正相关（R=0.579）。当肿瘤减容率为12.5%作为评价新辅助化疗的有效阈值时，ROC曲线下的AUC最大，敏感性和特异性分别为81.1%和75.9%。有效组和无效组的中位生存时间分别为25个月和18个月，2年生存率分别为73.3%和51.2%。有效化疗患者的总生存时间明显长于无效化疗患者（P=0.003 6）。结论容积测量分级标准可以预测新辅助化疗患者的病理回归，在疗效和预后评估方面优于Recist评分。关键词：胃肿瘤；螺旋计算机断层扫描；放化疗、辅助治疗；预后

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中华普通外科杂志

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