Application value of the volumetric method in assessing the effectiveness of nonoperative treatment for patients with non-small cell lung cancer
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摘要:
目的 分析非手术治疗后，在评估晚期非小细胞肺癌患者时，肿瘤体积与肿瘤最大直径[基于实体肿瘤疗效评价标准（RECIST）1.1版]是否相互关联，并评估晚期非小细胞肺癌肿瘤体积变化在疗效评估中的应用价值。 方法 回顾性分析108例经穿刺活检病理证实为非小细胞肺癌患者的CT影像学资料并进行随访，使用体积测量软件对治疗前后病灶体积进行测量，记录体积测量值与病灶最大直径，分别通过体积方法与RECIST 1.1版对疗效进行评估，并根据不同标准，将完全缓解和部分缓解归为缓解组，将疾病稳定与疾病进展归为未缓解组。采用Spearman相关系数评估RECIST最大直径与体积治疗前后变化率之间的相关性，采用Kaplan-Meier曲线评估不同评价标准中患者生存率之间的相关性。 结果 通过基线扫描和第1次随访扫描，计算了体积与直径相对于基线测量的变化率，评估结果显示两者具有中度相关性（r=0.881，P < 0.01）。在第1次随访中通过体积标准评估缓解组与未缓解组的K-M生存曲线的差异有统计学意义（P=0.002），根据RECIST标准进行评估时，两组差异无统计学意义（P=0.828）。 结论 体积测量对非小细胞肺癌治疗后疗效评估具有较好的应用价值。 -
关键词:
- 肺癌 /
- 非小细胞肺癌 /
- 体积测量 /
- RECIST疗效评估
Abstract:Objective To analyze whether tumor volume and tumor maximum diameter [based on the criteria for evaluating the efficacy of solid tumors (RECIST) version 1.1] are correlated with each other in evaluating patients with advanced non-small cell lung cancer (NSCLC) after non-surgical treatment and to assess the value of the application of the changes in tumor volume of advanced NSCLC in the evaluation of efficacy. Methods We retrospectively analyzed the CT imaging data of 108 patients with pathologically confirmed NSCLC by puncture biopsy and followed them up, measured the volume of the lesions before and after treatment using volumetric software, recorded the volume measurement values with the maximum diameter of the lesions, and then evaluated the therapeutic efficacy by the volumetric method and RECIST version 1.1, respectively. The complete response and partial response were categorized into the partial responders, and stable disease and progressive disease were categorized into the non-responders according to different criteria. Spearman correlation coefficients were used to assess the correlation between the maximum diameter of RECIST and the rate of change in volume before and after treatment, and Kaplan-Meier curves were used to evaluate the association between the survival of patients in different evaluation criteria. Results The rate of change of volume versus diameter relative to baseline measurements was calculated by baseline and first follow-up scans, and the assessment showed a moderate correlation (r=0.881, P < 0.01). The difference between the Kaplan-Meier curves of the responders and non-responders as assessed by the volume criterion at first follow up was statistically significant (P=0.002), and the difference between the two groups was not statistically significant when assessed according to the RECIST criterion (P=0.828). Conclusion Volumetric measurements have good application value for the assessment of the efficacy of NSCLC after treatment. -
图 2 非小细胞肺癌患者治疗前后病灶大小变化图
Figure 2. Changes in lesion size before and after treatment in non-small cell lung cancer patients. A-B: Female, 74 years old, with a maximum diameter of 80 mm and volume of 292 613.00 mm3 before treatment (A) and 61 mm and volume of 70 553.70 mm3 after treatment (B). Volume criteria were assessed as partial response and RECIST criteria as stable disease. C-D: Female, 49 years old with a maximum diameter of 29 mm and volume of 12 737.00 mm3 before treatment (C) and 26 mm and volume of 7991.80 mm3 after treatment (D). Volume criteria were assessed as partial response and RECIST criteria as stable disease.
图 3 体积分组（A）与直径分组（B）的患者生存曲线图
Figure 3. Patient survival curves in volume(A) and diameter(B) group.
表 1 治疗反应评估标准的比较
Table 1. Comparison of criteria for evaluation of treatment response
Criteria Complete response Partial response Progressive disease Stable disease RECIST1.1(2D) Disappearance of the lesions 30% decrease in diameter 20% increase in diameter Neither partial response nor progressive disease criteria met Volume(3D) Disappearance of the lesions 30% decrease in volume 20% increase in volume Neither partial response nor progressive disease criteria met RECIST: Response evaluation criteria in solid tumors. 
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表 2 患者基线特征
Table 2. Characteristics of the study patients
Variables n(%) Age(years) <60 29(26.85) ≥60 79(73.15) Gender Male 76(70.37) Female 32(29.63) Histology Squamous cell carcinoma 50(46.30) Adenocarcinoma 53(49.07) Other NSCLC 5(5.63) Smoking Yes 69(63.89) No 39(36.11) Drinking Yes 34(31.48) No 74(68.52) Chronic diseases Yes 73(67.59) No 35(32.41) RECIST1.1 Partial responder 27(25.00) Non-responder 81(75.00) Volume Partial responder 72(66.67) Non-responder 36(33.33)
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表 3 RECIST1.1标准及体积标准疗效评估结果
Table 3. RECIST1.1 and Volume assessment results (n)
RECIST1.1 Volume Total PR SD PD PR 27 0 0 27 SD 45 21 8 74 PD 0 0 7 7 Total 72 21 15 108
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表 4 患者基线特征的单因素及多因素COX回归分析
Table 4. Uni-and multivariable cox analysis of patient baseline characteristics
Characteristic Univariable survival analysis Multivariable survival analysis HR（95% CI） P HR（95% CI） P Gender 1.88(1.13-3.15) 0.016 1.27(0.56-2.86) 0.570 Age 1.82(1.06-3.10) 0.029 1.61(0.93-2.79) 0.086 Smoking 1.87(1.15-3.03) 0.012 1.25(0.57-2.76) 0.582 Histology 0.77(0.55-1.07) 0.120 Drinking 1.06(0.66-1.69) 0.819 Chronic diseases 0.99(0.62-1.56) 0.952 RECIST1.1 0.95(0.57-1.57) 0.828 Volume 0.48(0.30-0.76) 0.002 0.56(0.34-0.93) 0.024
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