CAJ | 학술논문

目的以双源容积灌注CT(VPCT)评价吉非替尼治疗EGFR突变的晚期人肺腺癌的近期效果.方法 2010年7月到2011年2月中南大学湘雅医院收治初治EGFR突变的晚期肺腺癌患者12例,其中男5例,女7例,年龄36～69岁,中位年龄53岁.在吉非替尼治疗前后行VPCT,用RECIST标准评价近期疗效,比较治疗前后VPCT灌注参数(血流量,血容量和表面通透性)的变化及其与分化程度及近期疗效的关系.结果治疗6周后,血流量上升的病例疗效欠佳(P =0.030),治疗前血流量和表面通透性与分化程度均呈负相关(r=-0.603,P=0.038和r=-0.694,P=0.012)；血流量下降率与分化程度呈负相关(r=-0.686,P=0.029),血流量变化趋势与RECIST评分呈明显负相关(r=-0.707,P=0.010),与分化程度无相关(P =0.059).将血流量下降认为靶向治疗达部分缓解,VPCT预测RECIST评价有效的敏感性、特异性、准确性、阳性预测值及阴性预测值分别为100％、66.7％、83.3％、75.0％及100％.结论双源VPCT能有效评价肺腺癌患者吉非替尼治疗前后肺癌血管灌注情况的变化,对判断疗效具有重要价值.
목적 이쌍원용적관주CT(VPCT)평개길비체니치료EGFR돌변적만기인폐선암적근기효과.방법 2010년7월도2011년2월중남대학상아의원수치초치EGFR돌변적만기폐선암환자12례,기중남5례,녀7례,년령36～69세,중위년령53세.재길비체니치료전후행VPCT,용RECIST표준평개근기료효,비교치료전후VPCT관주삼수(혈류량,혈용량화표면통투성)적변화급기여분화정도급근기료효적관계.결과 치료6주후,혈류량상승적병례료효흠가(P =0.030),치료전혈류량화표면통투성여분화정도균정부상관(r=-0.603,P=0.038화r=-0.694,P=0.012)；혈류량하강솔여분화정도정부상관(r=-0.686,P=0.029),혈류량변화추세여RECIST평분정명현부상관(r=-0.707,P=0.010),여분화정도무상관(P =0.059).장혈류량하강인위파향치료체부분완해,VPCT예측RECIST평개유효적민감성、특이성、준학성、양성예측치급음성예측치분별위100％、66.7％、83.3％、75.0％급100％.결론 쌍원VPCT능유효평개폐선암환자길비체니치료전후폐암혈관관주정황적변화,대판단료효구유중요개치.
Objective To investigate tumor vascularity by dual source volume perfusion computed tomography(VPCT)in advanced lung adenocarcinoma with positive EGFR-mutant and determine whether any of the VPCT parameters would predict the tumor response to gefitinib.Methods Twelve patients(5 males and 7 females,Median age:53 years,range:36-69 years)with advanced lung adenocarcinoma received VPCT scan.All patients with positive EGFR-mutant were confirmed by pathological biopsy.After a 6-week therapy of gefitinib,VPCT was repeated and the short-term effect evaluated by the RECIST criteria.The VPCT parameters(blood volume,blood flow and permeability surface)of 12 patients were compared with their differentiation grade and short-term effect.Results Short-term effects were poor in those cases in whom BF increased after a 6-week of targeted therapy(P =0.030).BF and PS at pre-therapy were negatively correlated with differentiation grade(r =-0.603,-0.694,P =0.038,0.012).There was a negative correlation between the rate of BF decline and differentiation grade(r =-0.686,P =0.029); a negative correlation existed between the trend of BF and RECIST criteria(r =-0.707,P =0.010).But there was no significant correlation with differentiation grade(P =0.059).If the BF decline was considered effective,the dual source VPCT could predict the effect of RECIST criteria.The sensitivity,specificity,accuracy,positive predictive value and negative predictive value of VPCT was 100％,66.7％,83.3％,75％ and 100％ respectively.Conclusion Dual source VPCT of advanced lung adenocarcinoma can assess effectively tumor vascularity and perfusion changes after the therapy of gefitinib.It is important in evaluating the response of targeted therapy in lung cancer.