肝细胞癌免疫/靶向治疗中肿瘤评效标准比较  

Tumor Evaluation Criteria in Hepatocyte Immune/Targeted Therapy:A Comparative Study

作　　者：韩帅 谷小磊 李晓婷[2] 曲金荣 崔湧[2] 孙应实[2] HAN Shuai;GU Xiaolei;LI Xiaoting;QU Jinrong;CUI Yong;SUN Yingshi(Department of Medical Imaging,Peking University Cancer Hospital&Institute,Key Laboratory of Carcinogenesis and Translational Research(Ministry of Education/Beijing),Beijing 100142,China;不详)

机构地区：[1]郑州大学附属肿瘤医院(河南省肿瘤医院)放射科,河南郑州450008 [2]北京大学肿瘤医院暨北京市肿瘤防治研究所医学影像科恶性肿瘤发病机制及转化研究教育部重点实验室,北京100142

出　　处：《中国医学影像学杂志》2021年第10期1022-1027,1034,共7页Chinese Journal of Medical Imaging

基　　金：国家自然科学基金项目(61520106004)。

摘　　要：目的比较实体瘤疗效评价标准(RECIST 1.1)、改良实体瘤评价标准(mRECIST)、欧洲肝病学会标准(EASL)、肿瘤体积评估标准(vRECIST)和三维定量强化体积评估标准(qEASL)对中晚期肝细胞癌(HCC)免疫/靶向治疗疗效评估的价值。资料与方法回顾性分析行靶向/免疫治疗的54例经临床或穿刺活检病理诊断为中晚期HCC患者的动态增强CT及临床信息,应用5种标准进行疗效评价。结果5种标准的疾病控制率差异无统计学意义(χ^(2)=1.468,P>0.05),客观缓解率差异有统计学意义(χ^(2)=23.46,P<0.001)。以mRECIST评价病灶治疗前后大小变化差异有统计学意义(t=2.187,P<0.05),其他标准差异无统计学意义(t=0.426、0.667、0.074、0.667,P>0.05)。mRECIST无效组、伴有静脉癌栓、伴有远处转移患者生存曲线明显下降,差异有统计学意义(P均<0.05)。结论mRECIST适用于评估免疫/靶向治疗的中晚期HCC治疗疗效,其评价无效、静脉癌栓及远处转移是预测生存的独立危险因素。Purpose To explore the value of efficacy evaluation criteria for solid tumors(RECIST 1.1),modified response evaluation criteria in solid Tumors(mRECIST),the European Association for the Study of the Liver(EASL),tumor volume evaluation criteria(vRECIST)and quantitative EASL(qEASL)in patients with advanced hepatocellular carcinoma(HCC)immune/targeted therapy efficacy evaluation.Materials and Methods A total of 54 patients with advanced HCC confirmed by pathology and received targeted/immunotherapy were retrospectively enrolled,and the plain scan,multi-phase enhanced CT scan and clinical information of all patients with advanced HCC were further analyzed.Moreover,the five evaluation criteria were used to evaluate the treatment efficacy.Results There was no statistically significant difference in the disease control rate among the five groups of evaluation criteria(χ^(2)=1.468,P>0.05),and there was statistically significant difference in the objective remission rate of the disease among the five groups(χ^(2)=23.46,P<0.001).There were statistically significant differences in tumor size before and after treatment with mRECIST criteria(t=2.187,P<0.05),while there were no statistically significant differences in tumor size before and after treatment with other criteria(t=0.426,0.667,0.074 and 0.667,P>0.05).Survival analysis showed that the survival curve of patients in the treatment-ineffective group,patients with venous tumor thrombus,and patients with distant metastasis was significantly reduced according to the mRECIST standard,and the difference was statistically significant(all P<0.05).Conclusion The mRECIST standard could be more suitable for evaluating the efficacy of immune/targeted therapy in the treatment of intermediate and advanced HCC.The mRECIST standard could be an independent risk factor for predicting survival in patient with ineffective treatment,accompanied by venous tumor thrombus and distant metastasis.

关 键 词：癌 肝细胞 体层摄影术 X线计算机 治疗结果 病理学 外科 疗效评价标准 生存分析 

分 类 号：R735.7[医药卫生—肿瘤] R445.3[医药卫生—临床医学]