European Radiology:这些MRI征象为晚期肝内胆管细胞癌患者提供个性化服务!

2022-08-01 shaosai MedSci原创

现阶段,临床上迫切需要一个可靠的无创手段来预测肝内胆管细胞癌患者对系统治疗的反应,以寻找合适的治疗对象和优化个体治疗策略。

肝内胆管细胞癌(ICC)是仅次于肝细胞癌的第二大原发性肝癌,是一种高致死性的肝胆恶性肿瘤,预后差,大多数患者在确诊时已为晚期无法进行手术切除。因此,化疗、靶向治疗和免疫治疗是该类患者最常选择的治疗手段

然而,对联合系统治疗的反应不同,患者经常出现原发性或继发性耐药。因此临床上迫切需要一个可靠的无创手段来预测患者对系统治疗的反应,以寻找合适的治疗对象和优化个体治疗策略。在成像技术中,磁共振成像(MRI)优于其他肝脏成像方式,可以提供多参数信息且没有辐射暴露。最近的研究已经证明了MRI在ICC预后评估中的潜力,但几乎没有研究涉及联合系统治疗的疗效评估。

近日,发表在European Radiology杂志的一项研究探讨了治疗前MRI在预测晚期ICC患者系统治疗反应方面的价值,为临床治疗前准确评估患者治疗反应并制定个性化治疗方案提供了参考。

项回顾性研究招募了61名ICC参与者,对每位患者在联合系统治疗前进行对比增强MRI检查。通过单变量和多变量逻辑回归分析比较了有治疗反应和无治疗反应患者的临床特征和MRI特征。然后,根据多变量分析的结果,建立了基于MRI的联合模型和列线图。评估和比较了重要表现和联合模型的诊断性能。比较了综合指数高和低的患者的无进展生存(PFS)率。 

30名(49.18%)患者在治疗后出现总体反应。在多变量分析中,肿瘤边缘(几率(OR)=5.004,P=0.014)、T2均匀性(OR=14.93,P=0.019)和瘤周动脉强化(OR=5.076,P=0.042)是与治疗反应有关的独立预测因素。纳入这三个独立影像学特征的制定的列线图的C-指数为0.828(95% CI 0.710-0.913)。综合指数的诊断特征优于任何单独的特征(P = 0.0007-0.0141)。综合指数值高的ICC显示出比低值的ICC有更高的PFS率(χ2 = 13.306,P < 0.0001)。 


 一名患有肝内胆管癌的67岁男性患者的图像。a T2加权图像显示右叶有一个大的异质性高信号肿瘤,边缘不规则。b强化前T1加权图像显示肿瘤低信号,c增强动脉期图像显示中度边缘强化,伴有动脉样周围强化(白色箭头)门静脉(d)和延迟期(e)图像显示出渐进式增强模式。f 弥散加权图像显示非边缘性高信号。 g 进展发生在治疗后2个月的首次随访中,肝脏中出现多个新病灶

本研究表明,包括肿瘤边缘、T2信号均匀性和APE在内的MRI特征是预测晚期ICC系统性治疗反应的潜在因素,而纳入这三个重要的MRI特征的组合模型取得了极好的预测效果,这对识别合适的治疗对象和优化个体治疗策略起到了重要作用。

 

原文出处:

Ruofan Sheng,Xiaoyong Huang,Kaipu Jin,et al.Contrast-enhanced MRI could predict response of systemic therapy in advanced intrahepatic cholangiocarcinoma.DOI:10.1007/s00330-022-08679-6

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