重组人血管内皮抑制素单药对非小细胞肺癌肿瘤血管微环境影响的初步研究  

Microenvironment changes induced by Endostar monotherapy in patients with non-small cell lung cancer:a pilot study

作　　者：沈钰新[1] 赵伟新[1] 王升平[2] 陈佳艳[1,3] 刘笛[1] 蒋国 樊旼[1] 

机构地区：[1]复旦大学附属肿瘤医院放疗科复旦大学上海医学院肿瘤学系,上海200032 [2]复旦大学附属肿瘤医院放射诊断科复旦大学上海医学院肿瘤学系,上海200032 [3]南京医科大学附属南京第一医院放疗科,江苏南京210006

出　　处：《中国癌症杂志》2015年第10期817-822,共6页China Oncology

摘　　要：背景与目的:临床数据显示对于局部晚期或晚期非小细胞肺癌(non-small cell lung cancer,NSCLC),重组人血管内皮抑制素(恩度)联合放疗或化疗较传统化放疗可能更具优势,但其机制,特别是对血管微环境的影响依旧不甚明确。该研究通过CT灌注成像技术(dynamic contrast-enhanced perfusion computed tomography,CT perfusion)对NSCLC肿瘤局部血流灌注进行定量分析,评估恩度单药对NSCLC肿瘤血管微环境的影响。方法:经细胞学或组织学确认的初治ⅢB/Ⅳ期NSCLC患者可入组本研究。全部患者接受7.5 mg?m2恩度单药治疗14 d,于基线期及治疗后分别接受CT灌注成像检查,获取灌注图像并定量分析血流灌注参数:血流量(blood flow,BF)、血容量(blood volume,BV)以及血管表面通透性(permeability surface,PS)。结果:7例患者(4例为ⅢB期,3例为Ⅳ期)入组,均完成基线期及恩度单药治疗后CT灌注扫描。血流灌注参数BF、BV、PS的中位值于治疗前后分别为27.1/48.9 m L·(100 m L·min)-1、86.8/84.8 m L·100 m L-1以及45.0/54.0 m L·(100m L·min)-1。经过14 d恩度单药治疗,肿瘤BF值较治疗前显著上升(P=0.028),而BV值与PS值变化无统计学意义(BV:P=0.398;PS:P=0.237)。结论:恩度单药治疗局部晚期或晚期NSCLC后,可导致肿瘤局部灌注血流量明显上升而通透性和血容量则变化不明显。Background and purpose：Clinical data show that Endostar, a recombinant human endostatin, has the therapeutic beneift for patients with non-small cell lung cancer （NSCLC） while combined with chemotherapy or ra-diotherapy. However, the microenvironment changes induced by Endostar monotherapy in NSCLC is not yet clear. The purpose of this study was to prospectively study tumor vascular effects of Endostar monotherapy in patients with locally advanced or advanced NSCLC by dynamic contrast-enhanced perfusion computed tomography （CT perfusion, CT-p）. Methods：Previously untreated patients with histologically or cytologically conifrmed locally advanced or advanced NSCLC were eligible. All patients received daily Endostar （7.5 mg？m2） for 14 days. CT-p scans were acquired at the baseline and post-treatment. CT-p parameters, such as blood lfow （BF）, blood volume （BV） and permeability surface PS （area product）, were measured in all patients.Results：Of all 7 patients enrolled, four were staged asⅢB and three as stageⅣ （2 with malignant pleural effusion, 1 with brain metastasis）. The median BF, BV and PS values of baseline and post-treatment were 27.1/48.9 mL/100 mL/min, 86.8/84.8 mL/100 mL and 45.0/54.0 mL/100 mL/min, respectively. After administration of Endostar for 14 days , BF showed a signiifcant increase compared with that at baseline （P=0.028）, whereas no signiifcant changes were found in BV （P=0.398） and PS （P=0.237） values.Conclusion：Our results suggest that Endostar monotherapy induces a signiifcant increase in BF whereas no signiifcant difference in BV and PS.

关 键 词：非小细胞肺癌 内皮抑素 CT灌注成像 肿瘤微环境 

分 类 号：R734.2[医药卫生—肿瘤]