Purpose

To evaluate the role of dynamic contrast-enhanced CT (DCE-CT) as an independent non-invasive biomarker in predicting long term outcome in patients with metastatic renal cell carcinoma (mRCC) on antiangiogenic treatment.

Material and methods

Eighty two mRCC patients were prospectively enrolled from 09/2011 to 04/2015, out of which 71 were included in the final data analysis; the population was observed until 12/2020 to obtain complete overall survival data.

DCE-CT imaging was performed at baseline and 10 to 12 weeks after start of treatment with targeted therapy. DCE-CT included a dynamic acquisition after injection of 50 ml of nonionic contrast agent at 6 ml/s using a 4D spiral mode (10 cm z-axis coverage, acquisition time 43 sec, 100 kVp (abdomen), 80 kVp (chest), 80–100 mAs) on a dual source scanner (Definition FLASH, Siemens). Blood flow (BF) was calculated for target tumor volumes using a deconvolution model. Progression free survival (PFS) and overall survival (OS) were analyzed using Kaplan-Meier statistics (SPSS version 24).

Results

Patients were treated with either sunitinib, pazopanib, sorafenib, tivozanib, axitinib, or cabozantinib. A cut-off value of 50% blood flow reduction at follow-up allowed for identification of patients with favorable long-term outcome: Median OS in n = 42 patients with an average blood flow reduction of >50% (mean, 79%) was 34 (range, 14–54) months, while n = 21 patients with an average reduction of less than 50% (mean, 28%) showed a median OS of 12 (range, 6–18) months, and n = 8 patients with an increase in blood flow survived for a median of 7 (range, 3–11) months.

Conclusion

Blood flow in metastases measured with DCE-CT at first follow-up is a strong predictor of overall survival in mRCC patients on antiangiogenic treatment.

中文翻译：

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动态对比增强 CT 衍生的血流测量能够早期预测转移性肾细胞癌患者抗血管生成治疗的长期结果

目的

评估动态对比增强 CT (DCE-CT) 作为独立的非侵入性生物标志物在预测转移性肾细胞癌 (mRCC) 患者抗血管生成治疗的长期结果中的作用。

材料与方法

从 09/2011 到 04/2015 前瞻性纳入 82 名 mRCC 患者，其中 71 名纳入最终数据分析；对该人群进行观察直至 2020 年 12 月，以获得完整的总体生存数据。

DCE-CT 成像在基线和靶向治疗开始后 10 至 12 周进行。DCE-CT 包括使用 4D 螺旋模式以 6 ml/s 注射 50 ml 非离子造影剂后的动态采集（10 cm z 轴覆盖，采集时间 43 秒，100 kVp（腹部），80 kVp（胸部） , 80–100 mAs) 在双源扫描仪 (Definition FLASH, Siemens) 上。使用反卷积模型计算目标肿瘤体积的血流量 (BF)。使用 Kaplan-Meier 统计（SPSS 版本 24）分析无进展生存期 (PFS) 和总生存期 (OS)。

结果

患者接受舒尼替尼、帕唑帕尼、索拉非尼、替沃扎尼、阿西替尼或卡博替尼治疗。随访时血流减少 50% 的临界值允许识别具有良好长期结果的患者：n  = 42 名患者的中位 OS，平均血流减少 >50%（平均 79%）为 34（范围，14-54）个月，而n  = 21 名患者平均减少少于 50%（平均，28%）的中位 OS 为 12（范围，6-18）个月，n  = 8血流量增加的患者中位生存时间为 7（范围，3-11）个月。

结论

首次随访时用 DCE-CT 测量的转移灶血流量是 mRCC 患者接受抗血管生成治疗的总生存期的有力预测指标。