肿瘤生长速率在神经内分泌肿瘤早期疗效评估中的价值

Value of tumor growth rate in evaluating the early therapeutic efficacy of neuroendocrine neoplasm

目的探讨肿瘤生长速率(TGR)评估神经内分泌肿瘤(NEN)早期药物治疗疗效的临床应用价值。方法回顾性分析2010年1月至2018年12月于中国医学科学院北京协和医学院肿瘤医院就诊的NEN患者共30例,其中男16例,女14例,年龄26~73(53±11)岁。测量患者基线治疗前及治疗后3个月的靶病灶最大直径总和及检查间隔天数,利用公式计算治疗后3个月的TGR。采用组内相关系数(ICC)评估TGR测量观察者间一致性。采用受试者工作特征(ROC)曲线确定TGR预测无进展生存期(PFS)的最佳截断值。在治疗后3个月采用实体瘤疗效评价标准评估疗效,将评定为疾病稳定(SD)的患者及总体患者分别通过TGR最佳截断值分组;采用Kaplan-Meier法分析组间生存差异。采用多因素Cox比例风险回归模型分析TGR对于预后的影响。结果TGR最佳截断值是-5.8(%/月),ROC曲线下面积为0.921(95%CI:0.824~0.999,P<0.001),观察者间ICC为0.955(95%CI:0.907~0.978,P<0.001)。根据TGR分组,两组患者无进展生存差异有统计学意义(P<0.001)。多因素Cox分析显示相较于TGR<-5.8组,TGR≥-5.8组不论在总体患者(HR:10.906,95%CI:1.953~60.898,P=0.006)或是SD患者(HR:14.354,95%CI:1.602~128.627,P=0.017)中都观察到更高的进展风险,TGR≥-5.8是影响预后的独立危险因素。结论TGR能够反映NEN早期抗肿瘤药物治疗疗效并且与预后相关。

Objective To determinate the value of tumor growth rate(TGR)in evaluating the efficacy of early drug treatment for neuroendocrine neoplasm(NEN).Methods Patients with NEN who treated at Chinese Academy of Medical Sciences Cancer Hospital from January 2010 to December 2018 were retrospectively enrolled.A total of 30 patients(16 males and 14 females,aged from 26 to 73(53±11)years)were enrolled.The sum of largest diameter of target lesions and the interval time were measured,TGR of 3 months after the first treatment was calculated using a formula.Intraclass correlation coefficient(ICC)were used to test the repeatability of TGR.Receiver operating characteristic curve(ROC)analysis was used to determine the optimal cut-off values of TGR for predicting progression-free survival(PFS).Overall patients and SD patients assessed by RECIST were grouped by the optimal cut-off values of TGR.Kaplan-Meier method was used to estimate PFS rates and plot patient survival curves of patients at different group of TGR.Cox risk proportional hazard model was used to assess the effect of TGR on the prognosis.Results The optimal cut-off value of TGR was-5.8(%/m),the area under the curve was 0.921(95%CI:0.824-0.999,P<0.001).Interobserver ICC was 0.955(95%CI:0.907-0.978,P<0.001).Multivariate Cox analysis showed that compared with the patients with TGR<-5.8,the patients with TGR≥-5.8 had a higher risk of progression in either overall population(HR:10.906,95%CI:1.953-60.898,P=0.006)or the SD population(HR:14.354,95%CI:1.602-128.627,P=0.017);TGR≥-5.8 was an independent risk factor affecting the prognosis of NEN.Conclusions TGR can evaluate the efficacy of NEN′s early anti-tumor drug treatment,and associate with prognosis.