CT灌注成像对表皮生长因子受体酪氨酸激酶抑制剂治疗肺腺癌疗效的评估价值研究

Efficacy Evaluation of EGFR-TKI for Lung Adenocarcinoma by CT Perfusion Imaging

目的探讨CT灌注成像(CTPI)对表皮生长因子受体酪氨酸激酶抑制剂(EGFR-TKI)治疗肺腺癌临床疗效的评估价值。方法选择2011年11月—2013年7月在河北医科大学第四医院肿瘤内科、呼吸科和胸外科采用EGFR-TKI二线治疗的肺腺癌患者32例。根据疗效将患者分为缓解组和未缓解组。收集患者一般资料(年龄、性别、体力状况、临床分期),对比分析两组患者治疗前和治疗后2、4、6个月病灶CTPI参数〔血流量(BF)、血容量(BV)、平均通过时间(MTT)、表面通透性(PS)〕。结果缓解组11例,未缓解组21例。缓解组患者年龄为(55.2±3.2)岁,未缓解组为(57.4±4.5)岁,差异无统计学意义(t=1.437,P=0.163)。两组患者男性比例、美国东部肿瘤协作组(ECOG)评分、临床分期比较,差异均无统计学意义(P>0.05)。两组患者BF、BV与时间存在交互作用(P<0.05);BF、BV在不同时间点比较,差异有统计学意义(P<0.05);BV在不同组间比较,差异有统计学意义(P<0.05)。缓解组BF治疗后4、6个月均低于治疗前和治疗后2个月(P<0.05)。缓解组BV治疗后2、4、6个月均低于治疗前,治疗后4个月低于治疗后2个月,治疗后6个月高于治疗后4个月(P<0.05);未缓解组BV治疗后4、6个月均高于治疗前,治疗后6个月高于治疗后2个月和治疗后4个月(P<0.05)。结论 CTPI可以量化反映肿瘤微血管的代谢功能,为精准评价EGFR-TKI二线治疗肺腺癌的疗效提供参考。

Objective To investigate the evaluation value of CT perfusion imaging （CTPI） for EGFR - TKI treatment for lung adenocarcinoma. Methods The study enrolled 32 patients with lung adenooareinoma who underwent EGFR - TKI second - line treatment in the Department of Medical Oncology, the Department of Pneumology and the Department of Chest Surgery of the Fourth Hospital of Hebei Medical University from December 2011 to July 2013. According to efficacy, the patients were divided into remission group and non - remission group. The general data of the subjects were collected, including age, gender, performance status and clinical staging. Before treatment, and two months, four months and six months after treatment, comparison was made between the two groups on CTPI parameters （BF, BV, MTF and PS） . Results The study assigned 11 patients to the remission group and 21 patients to the non -remission group. The age range was （55.2 ＋ 3.2） for the remission group and （57.4 ~： 4. 5 ） for the non - remission group, with no significant difference between them （ t = 1. 437, P = O. 163 ）. The two groups were not significantly different in the proportion of male patients, ECOG score and clinical staging （P 〉 0.05 ）. Interaction effect was noted between BF, BV and time （ P 〈 0. 05 ） ; significant difference was noted between BF and BV at different time points （ P 〈 0. 05 ） ; BV was significantly different between the two groups （ P 〈 0. 05 ） . Four months and six months after treatment, BF decreased significantly in patients of the remission group, compared with two months before and after treatment （P 〈 O. 05） . The remission group had lower BV two months, four months and six months after treatment than that before treatment （P 〈 O. 05）, and it had lower BV four months after treatment than two months after treatment （ P 〈 O. 05）, while it had higher BV six months after treatment than four months after treatment （ P 〈 0. 05 ） . The non - remission group had higher BV four months and six months after treatment than before treatment, and it had higher BV six months after treatment than two months and four months after treatment. Conclusion CTPI can reflect quantitative tumor microvascular metabolic function of capillaries in tumors, it provides references for accurate efficacy evaluation of EGFR -TKI second - line treatment for lung adenocarcinoma.