在晚期鼻咽癌的疗效预测方面，通过磁共振成像测量体积来评估诱导化疗的治疗反应优于RECIST指南。

IF 7.1 2区医学 Q1 ONCOLOGY

ESMO Open Pub Date : 2024-10-01 DOI:10.1016/j.esmoop.2024.103933

T.S.A. Kwong , H.S. Leung , F.K.F. Mo , Y.M. Tsang , L. Lan , L.M. Wong , T.Y. So , E.P. Hui , B.B.Y. Ma , A.D. King , Q.Y.H. Ai

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引用次数: 0

摘要

背景：根据肿瘤大小变化评估治疗反应是预测疗效的重要指标。晚期鼻咽癌（adNPC）生长不规则，因此单维测量可能无法准确用于晚期鼻咽癌的疗效预测。本研究旨在评估诱导化疗（IC）治疗反应的单维测量值和容积测量值，以预测 adNPC 的治疗结果，并将其与 RECIST 1.1 指南的测量值进行比较：对124例III-IVA期鼻咽癌患者治疗前和化疗后的磁共振图像（MRI）进行回顾性研究。计算治疗前（Dpre 和 Vpre）和治疗后（Dpost-IC 和 Vpost-IC）磁共振成像上目标肿瘤（原发肿瘤和两个最大的转移淋巴结）的最大单维直径 (D) 和体积之和，以及两次扫描之间 D (Δ D%) 和 V (Δ V%) 的百分比变化，并将其与无病生存率 (DFS) 相关联、通过 Cox 回归分析，计算出两次扫描之间的无疾病生存期（DFS）、无局部复发生存期（LRRFS）和无远处转移生存期（DMFS）的百分比，并将其与无疾病生存期（DFS）相关联。使用 DeLong 检验计算并比较了独立测量值和 RECIST 组（RECIST 反应组和无反应组）预测疾病复发、局部复发和远处转移的曲线下面积（AUC）：单变量分析显示，高Dpost-IC与不良DFS和DMFS相关（P < 0.05），但与LRRFS无关（P = 0.07）；高Vpost-IC和低ΔV%（IC后体积减少较少）与不良DFS、LRRFS和DMFS相关（P < 0.05）；Dpre、ΔD%和Vpre与结果无相关性（P > 0.05）。多变量分析表明，ΔV%是唯一与预后相关的独立测量指标（P＜0.05）。与RECIST组相比，47.9%的ΔV%（中位值）在疾病复发（0.682对0.526，P＜0.01）和局部复发（0.782对0.585，P＜0.01）方面显示出更高的AUC，但在远处转移（0.593对0.518，P=0.26）方面却没有显示出更高的AUC：结论：用体积测量法评估对IC的治疗反应，在预测腺鼻咽癌的预后方面优于单维测量法和RECIST指南。

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Volumetric measurement to evaluate treatment response to induction chemotherapy on MRI outperformed RECIST guideline in outcome prediction in advanced nasopharyngeal carcinoma

Background

Treatment response evaluated by tumour size change is an important indicator for outcome prediction. Advanced nasopharyngeal carcinoma (adNPC) grows irregularly, and so the unidimensional measurement may not be accurately applied to adNPC for outcome prediction. This study aimed to evaluate values of unidimensional and volumetric measurements for treatment response to induction chemotherapy (IC) for outcome prediction in adNPC and compared the values with that of RECIST 1.1 guideline.

Materials and methods

Pre-treatment and post-IC magnetic resonance images (MRIs) from 124 patients with stage III-IVA NPC were retrospectively reviewed. Sums of the maximum unidimensional diameters (D) and volumes of the targeted tumours (primary tumour and two largest metastatic lymph nodes) on the pre- (D_pre and V_pre) and post-IC MRIs (D_post-IC and V_post-IC) and percentage changes in D (Δ D%) and V (ΔV%) between two scans were calculated and correlated with disease-free survival (DFS), locoregional recurrence-free survival (LRRFS), and distant metastases-free survival (DMFS) using Cox regression analysis. Area under the curves (AUCs) of independent measurements and RECIST groups (RECIST response and non-response groups) for predicting disease recurrence, locoregional recurrence, and distant metastases, respectively, were calculated and compared using the DeLong test.

Results

Univariable analysis showed correlations between high D_post-IC with poor DFS and DMFS (P < 0.05), but not with LRRFS (P = 0.07); high V_post-IC and low ΔV% (less decrease in volume on post-IC) with poor DFS, LRRFS, and DMFS (P < 0.05); and no correlations between D_pre, ΔD%, and V_pre and the outcomes (P > 0.05). Multivariable analysis showed that ΔV% was the only independent measurement for outcomes (P < 0.05). Compared with RECIST groups, ΔV% of 47.9% (median value) showed a higher AUC for disease recurrence (0.682 versus 0.526, P < 0.01) and for locoregional recurrence (0.782 versus 0.585, P < 0.01), but not for distant metastases (0.593 versus 0.518, P = 0.26).

Conclusions

Volumetric measurement to evaluate treatment response to IC outperformed unidimensional measurement and RECIST guideline in outcome prediction in adNPC.

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来源期刊

ESMO Open Medicine-Oncology

CiteScore

11.70

自引率

2.70%

发文量

255

审稿时长

10 weeks

期刊介绍： ESMO Open is the online-only, open access journal of the European Society for Medical Oncology (ESMO). It is a peer-reviewed publication dedicated to sharing high-quality medical research and educational materials from various fields of oncology. The journal specifically focuses on showcasing innovative clinical and translational cancer research. ESMO Open aims to publish a wide range of research articles covering all aspects of oncology, including experimental studies, translational research, diagnostic advancements, and therapeutic approaches. The content of the journal includes original research articles, insightful reviews, thought-provoking editorials, and correspondence. Moreover, the journal warmly welcomes the submission of phase I trials and meta-analyses. It also showcases reviews from significant ESMO conferences and meetings, as well as publishes important position statements on behalf of ESMO. Overall, ESMO Open offers a platform for scientists, clinicians, and researchers in the field of oncology to share their valuable insights and contribute to advancing the understanding and treatment of cancer. The journal serves as a source of up-to-date information and fosters collaboration within the oncology community.