转移性肾细胞癌舒尼替尼治疗前后CT征象变化

Evaluation on CT Image Characteristics in the Metastatic Renal Cell Cancer Treated by Sunitinib

目的观察转移性肾细胞癌舒尼替尼治疗前后CT征象的变化,探讨与疗效相关的特异性征象,为更全面客观地评价疗效奠定基础。资料与方法 20例接受舒尼替尼治疗的转移性肾透明细胞癌患者于治疗前及治疗后1、4周期行CT增强扫描。依照实体瘤疗效评价标准(RECIST)选取靶病灶51个,观察病灶强化程度、强化类型、最大长径及最大层面CT值,计算治疗后CT值变化率及长径变化率,比较治疗前及治疗1周期后CT值变化率及长径变化率,分析CT值变化率与长径变化率之间的相关性及治疗前后强化类型比例差异。结果 51个病灶中,第1、4周期治疗后分别有34个及40个病灶强化程度下降,治疗后强化模式比例分布差异有统计学意义(x2=52.003,P<0.001)。治疗后1周期,病灶长径变化率与CT值变化率呈正相关(r=0.508,P=0.001),病灶长径变化率明显低于CT值变化率(27.2%对50.3%,t=-4.112,P<0.001)。以患者为单位评价,患者CT均值变化率与长径和变化率呈正相关(r=0.821,P=0.001)。长径和变化率明显低于CT均值变化率(25.1%对44.0%,t=-3.481,P=0.005)。结论转移性肾细胞癌舒尼替尼治疗后强化程度变化是伴随径线变化的另一特异性征象,治疗后CT值变化率可早期评价疗效。

Purpose To investigate the CT image characteristics of metastatic renal cell cancer during process of treatment by Sunitinib, and to explore its specificity and potential in therapy response evaluation. Materials and Methods 20 cases of metastatic renal cell cancer treated by Sunitinib were included in this retrospective study. CT axial images of pre-therapy and at the 1st and 4th cycle post-therapy were reviewed. 51 lesions were selected according to RECIST criteria. The longest diameter and CT attenuation coefficient （Hu） of the whole tumor were measured for each selected lesion. The sum of longest diameters and mean CT attenuation of all selected lesions in each patient were computed to achieve the decrease rates during treatment. Pearson＇s correlation coefficient was used to determine correlation while t-tests assessed differences of changes of diameter and CT attenuation pre- and post-therapy. Nonparametric test was used to analyze the enhancing patterns variation. Results Among the 51 lesions , the enhancement of 34 and 40 lesions decreased after the first and fourth cycle therapy respectively. The enhancing patterns between pre- and post-therapy were different （x2=52.003, P 0.001）. At the end of the first cycle therapy, the changes of diameter and CT attenuation were positively correlated （r=0.508, P=0.001）, while the changing ratio of diameter was significantly lower than that of the CT attenuation （27.2% vs. 50.3%, t=-4.112, P 0.001）. On patient based level, the changes in sum of longest diameter and that of mean Hu were strongly correlated （r=0.821, P=0.001）, with lower change in sum of diameter than the mean of CT attenuation （25.1% vs. 44.0%, t =- 3.481, P =0.005）. Conclusion The CT enhancement changes are specific during the treatment of metastatic renal cell cancer by Sunitinib. The changes of CT attenuation value may have the potential in evaluating therapeutic response.