胃肠间质瘤靶向治疗CT征象演变及其与预后的关系  

Association of CT image changes and prognosis in gastrointestinal stromal tumor after targeted therapy

作　　者：唐磊[1] 孙应实[1] 沈琳[2] 李健 曹崑[1] 齐丽萍[1] 崔湧[1] 张晓鹏[1] 

机构地区：[1]北京大学临床肿瘤学院北京肿瘤医院暨北京市肿瘤防治研究所恶性肿瘤发病机制及转化研究教育部重点实验室医学影像科,100142 [2]北京大学临床肿瘤学院北京肿瘤医院暨北京市肿瘤防治研究所恶性肿瘤发病机制及转化研究教育部重点实验室消化内科,100142

出　　处：《中华胃肠外科杂志》2010年第7期497-501,共5页Chinese Journal of Gastrointestinal Surgery

基　　金：国家“973”重点基础研究发展计划资助项目（2006CB705706）;国家自然科学基金（30970825）;北京市自然科学基金（7092020）

摘　　要：目的 探讨胃肠间质瘤（GIST）靶向治疗过程中CT征象变化及其预测预后的能力.方法 对2003年4月至2008年6月北京大学肿瘤医院35例口服甲磺酸伊马替尼的GIST患者的临床资料进行回顾性分析.于靶向治疗前和治疗后2～6个月进行CT检查,CT轴位图像测量肿瘤最长径线及最大层面平均强化CT值,计算治疗前后长径及强化CT值变化率.以2年内肿瘤是否进展作为评价预后的指标,比较进展与未进展组患者CT分类指标（病灶数目、部位、肝转移、出血、囊变）及定量指标（病灶长径、强化CT值及其变化率）的差异.结果 本组患者中位随访时间28.5个月,其中肿瘤进展组13例,肿瘤未进展组22例.靶向治疗前,病灶数目大于或等于5个、累及多个部位者2年内进展比例高于病灶数少于5个、累及单个部位者（P＜0.05）.未进展组肿瘤长径变化率及强化CT值变化率分别为-14.29%（-67%,11%）和-12.25%（-55%,39%）,与进展组长径变化率15.09%（-45%,191%）及强化CT值变化率9.91%（-27%,135%）比较,差异有统计学意义（P＜0.01）.以长径变化率和强化CT值变化率为评价指标预测2年进展的ROC曲线下面积分别为0.790和0.797.结论 GIST靶向治疗前,病变数目和累及部位数与预后有关;靶向治疗后,CT病灶长径退缩率和强化CT值具有中等预测效能,可作为疗效的评价指标.Objective To investigate the association between CT image changes and the prognosis in gastrointestinal stromal tumors （GIST） after targeted therapy. Methods A total of 35 patients with GIST were treated by imatinib mesylate from April 2003 to June 2008. The longest diameter （ID） and mean enhanced CT values（HU） of tumors were measured on axial images. The CT classifying （number, location, liver metastasis, hemorrhage,cystic degeneration） and quantitative indices （pre- and 2-6 months post-treatment LD, HU, and their change rate） were compared between those with and without progress in two years. Results During follow-up （median：285 months） 13 cases had tumor progress. The progress rate was higher in the group with extensive tumor involvement （≥ 5 lesions and ≥ 2 parts）, and that without hemorrhage demonstrated. The mean change rate was -14.29% （range, -67%, 11%） for LD and -12.25%（range, -55%,39%） for HU in non-progressive group, while the mean change rate was 15.09%（range,-45%, 191%）for LD and 9.91 %（-27%, 135%） for HU in progressive group. The differences were significantly different （P〈0.01）. The accuracies of predicting 2-year progress by LD and HU change rates were moderate, with area under ROC curve being 0.790 and 0.797, respectively. Conclusions The 2-year progress rate of GIST after targeted therapy is higher in extensively involved tumors. Higher decrease rates of ID and HU predict less 2-year progress, which possess moderate prediction accuracy and can be used as valuable indicators in the evaluation of targeted therapy for GIST.

关 键 词：胃肠间质瘤 体层摄影术 X线计算机 甲磺酸伊马替尼 预后 

分 类 号：R735[医药卫生—肿瘤]