CT灌注成像预测贝伐珠单抗治疗晚期非鳞非小细胞肺癌的疗效研究

Perfusion CT in predicting efficacy of bevacizumab treatment for patients with advanced non-small-cell lung cancer

目的 探讨CT灌注成像预测化疗联合贝伐珠单抗治疗晚期非鳞非小细胞肺癌的疗效。方法 收集2017年12月至2020年1月杭州市肿瘤医院18例和中山大学附属肿瘤医院6例晚期非鳞非小细胞肺癌患者共24例,在基线和培美曲塞/顺铂联合贝伐珠单抗治疗2周期后进行CT灌注成像扫描。分析肿瘤长径以及血流速度、血流量、平均通过时间及表面通透性等参数,并对基线和2个周期治疗后的CT灌注参数进行比较。结果 基线和2个周期治疗后的血流速度、表面通透性比较差异均有统计学意义(均P<0.05),而血流量、平均通过时间比较差异均无统计学意义(均P>0.05)。相关性分析结果提示,血流速度和血流量呈正相关(r=0.428,P<0.05),血流速度和平均通过时间呈负相关(r=-0.609,P<0.05)。部分缓解的患者比稳定或进展患者的基线血流速度的数值更高(P<0.05)。而基线血流量、平均通过时间和表面通透性在疗效为部分缓解、稳定或进展的患者间差异均无统计学意义(均P>0.05)。中位无进展生存期为5.5个月(95%CI:3.1~8.3),中位总生存期为13.5个月(95%CI:8.6~17.0)。最常见的血液学不良反应是白细胞下降(66.7%,其中3/4级为20.8%),最常见的非血液学不良反应是恶心、呕吐(50.0%,其中3级为12.5%)。结论 CT灌注成像可在一定程度上评价贝伐珠单抗治疗非鳞非小细胞肺癌疗效,是一个潜在预测指标。

Objective To evaluate the application of perfusion computed tomography(CT) in predicting efficacy of chemotherapy combined with bevacizumab treatment for patients with advanced non-squamous non-small-cell lung cancer(ns-NSCLC). Methods From December 2017 to January 2020, 24 patients with advanced ns-NSCLC admitted in Hangzhou Cancer Hospital and Sun Yat-Sen University Cancer Center were enrolled. All patients underwent perfusion CT at baseline and after 2 cycles of pemetrexed, cisplatin and bevacizumab treatment. RECIST measurements and calculations of blood flow, blood volume, mean transit time, and permeability were performed. Baseline CT perfusion parameters were also compared on the basis of the therapy response assessed by RECIST criteria. Results There were significant differences in blood flow or permeability value before and after treatment(P<0.05);while there were no significant differences in blood volume and mean transit time values. Pearson correlation showed a significant correlation between baseline values of blood flow and blood volume(r=0.428, P<0.05), and blood flow and mean transit time(r=-0.609, P <0.05). Baseline blood flow value was significantly higher in responding patients than that in other patients(P <0.05). No significant changes were found for baseline values of blood volume(P>0.05), mean transit time(P>0.05) and permeability(P>0.05), among patients with partial response, stable disease, or progressive disease. Median progression free survival was 5.5 months(95%CI: 3.1-8.3), median overall survival was 13.5 months(95% CI: 8.6-17.0). The most common hematologic toxicity was neutropenia(66.7%), in which grade 3/4 was 20.8%. The most common non-hematological toxicity was nausea/vomiting(50.0%), in which grade 3 was 12.5%. Conclusion Perfusion CT imaging may be used for evaluation of bevacizumab therapy in ns-NSCLC, as a potential indicator for prognosis of patients.