CTPI成像技术联合ctDNA评估进展期NSCLC TKI获得性耐药的临床研究

Clinical Study of CTPI Imaging Technology Combined with ctDNA to Assess Acquired Drug Resistance in Progressive NSCLC TKI

目的探讨低剂量CT灌注成像(CTPI)成像技术联合循环肿瘤DNA(ctDNA)评估进展期非小细胞肺癌(NSCLC)表皮生长因子受体酪氨酸激酶抑制剂(EGFR-TKI)获得性耐药价值。方法选取2019年1月至2021年10月127例有EGFR-TKI治疗史,并明确临床获益的进展期NSCLC患者,均给予EGFR-TKI治疗,根据治疗后是否发生获得性耐药分为耐药组、非耐药组。比较两组基线资料、治疗前和治疗后血容量、灌注值、强化峰值、强化峰值时间(TTP)、ctDNA,统计分析以上数据。结果耐药组治疗后血容量、灌注值、强化峰值、ctDNA高于非耐药组(P<0.05);血容量、灌注值、强化峰值、ctDNA均与EGFR-TKI获得性耐药相关(P<0.05);治疗前后血容量、灌注值、强化峰值、ctDNA差值评估EGFR-TKI获得性耐药的AUC分别为0.803、0.787、0.747、0.836;各指标联合的AUC为0.911,大于ctDNA及其他单一指标(P<0.05)。结论血容量、灌注值、强化峰值、ctDNA均与进展期NSCLC EGFR-TKI获得性耐药相关,联合应用CTPI成像技术、ctDNA可作为评估耐药一种方法,为临床EGFR-TKI合理应用提供重要参考信息。

Objective To investigate the value of low-dose CT perfusion imaging(CTPI)imaging technique combined with circulating tumor DNA(ctDNA)to assess acquired resistance to epidermal growth factor receptor tyrosine kinase inhibitors(EGFR-TKI)in progressive non-small cell lung cancer(NSCLC).Methods patients with a history of EGFR-TKI treatment and clear clinical benefit in progressive NSCLC from January 2019 to October 2021 were selected and given EGFR-TKI treatment,and were divided into drug-resistant and non-drug-resistant groups according to whether acquired drug resistance occurred after treatment.Baseline data,pre-and post-treatment blood volume,perfusion values,peak intensification,time to peak intensification(TTP),and ctDNA were compared between the two groups,and the above data were statistically analyzed.Results The pre-treatment and posttreatment blood volume,perfusion value,peak reinforcement,and ctDNA were higher in the drugresistant group than in the non-drug-resistant group(P<0.05);pre-treatment blood volume,perfusion value,peak reinforcement,and ctDNA were all associated with acquired resistance to EGFR-TKI(P<0.05);the AUCs of pre-treatment blood volume,perfusion value,peak reinforcement,and ctDNA for predicting acquired resistance to EGFR-TKI were 0.803,0.787,0.747,and 0.836,respectively,and the AUC for the combination of the above indicators was 0.911,which was greater than that of any single indicator(P<0.05).Conclusion Blood volume,perfusion value,peak reinforcement,and ctDNA are all associated with acquired resistance to EGFR-TKI in progressive NSCLC,and all can be used as markers for predicting drug resistance.The combined application of CTPI imaging technology and ctDNA can further improve the predictive value and provide important reference information for the rational clinical application of EGFR-TKI.