本文選題：腎細(xì)胞癌 + 索拉非尼�。� 參考：《上海醫(yī)學(xué)》2017年09期

【摘要】：目的應(yīng)用CT平掃圖像紋理特征評(píng)估抗腫瘤血管生成藥物索拉非尼治療腎癌肺轉(zhuǎn)移的療效。方法選擇87例接受索拉非尼治療的腎癌肺轉(zhuǎn)移患者,所有患者均于治療前和2個(gè)治療周期后行胸部CT平掃檢查,并采用實(shí)體腫瘤療效評(píng)價(jià)標(biāo)準(zhǔn)(RECIST)評(píng)估臨床效果。按入組時(shí)間將患者分為分析樣本組(2008年6月—2009年1月入組,60例)和驗(yàn)證組(2009年2月—2011年1月入組,27例),再根據(jù)無(wú)進(jìn)展生存期(PFS)將兩組患者分別分為PFS≥1年和PFS1年亞組。在分析樣本組中,通過(guò)ROC曲線獲得統(tǒng)計(jì)模型中的界斷值,采用逐步選擇的方法進(jìn)行判別分析,評(píng)價(jià)病灶直徑、CT值、熵和均勻性的變化,獲取分析樣本組用于評(píng)估療效的參數(shù)界斷值和統(tǒng)計(jì)模型,并將其用于驗(yàn)證組,應(yīng)用RECIST、各影像參數(shù)和判別分析建立卡普蘭-邁耶生存曲線。結(jié)果 2個(gè)治療周期后,分析樣本組兩亞組除病灶直徑均較治療前顯著增大(P值分別為0.03和0.04)外,CT值,以及不使用過(guò)濾器和采用不同過(guò)濾系數(shù)時(shí)的熵和均勻性與治療前的差異均無(wú)統(tǒng)計(jì)學(xué)意義(P值均0.05)。驗(yàn)證組兩亞組的病灶直徑、CT值,以及不使用過(guò)濾器和采用不同過(guò)濾系數(shù)時(shí)的熵和均勻性與治療前的差異均無(wú)統(tǒng)計(jì)學(xué)意義(P值均0.05)�？ㄆ仗m-邁耶生存曲線結(jié)果顯示,分析樣本組和驗(yàn)證組采用判別分析法評(píng)估腫瘤治療療效的效果(P值分別為0.02、0.04)均優(yōu)于單獨(dú)使用其他參數(shù);驗(yàn)證組中,RECIST的P值為0.21,CT值變化百分比的P值為0.49,在不使用過(guò)濾器和過(guò)濾系數(shù)為1.0、1.5、2.0、2.5時(shí)熵變化值百分比的P值分別為0.47、0.89、0.72、0.73和0.58,在不使用過(guò)濾器和過(guò)濾系數(shù)為1.0、1.5、2.0、2.5時(shí)均勻性變化百分比的P值分別為0.53、0.72、0.51、0.39和0.16。結(jié)論與單獨(dú)使用RECIST相比,結(jié)合治療前后影像參數(shù)包括病灶直徑、CT值、熵、均勻性等變化的判別分析,更有助于評(píng)估抗血管新生藥物治療腎癌肺轉(zhuǎn)移的療效。
[Abstract]:Objective to evaluate the effect of CT plain scan image texture on the treatment of lung metastasis of renal carcinoma with anti tumor angiogenesis drug Sola Fini. Methods 87 cases of renal carcinoma with lung metastases received Sola Fini were selected. All patients underwent chest CT scan before and after the treatment, and the evaluation criteria of solid tumor effect were adopted (RECIST The patients were divided into analysis sample group (June 2008 - 2009 1 month group, 60 cases) and verification group (February 2009 - 2011 1 month group, 27 cases), and then the two groups were divided into PFS > 1 years and PFS1 subgroups according to the progression free survival period (PFS). The statistical model was obtained by the ROC curve in the analysis sample group. By discriminant analysis in the stepwise selection method, the changes of the diameter, CT value, entropy and uniformity of the lesion were evaluated, and the parameter boundary value and the statistical model of the analysis sample group used to evaluate the effect were obtained and used in the validation group. The Kaplan Meyer survival curve was established by using the RECIST, the image parameters and the discriminant analysis. The results were 2. After the treatment period, the two subgroups of the two subgroup were significantly larger than before the treatment (0.03 and 0.04 respectively), and there was no significant difference between the CT value, the entropy and the uniformity of the group without the filter and the use of the different filter coefficients (P value, 0.05). The lesion diameter, the CT value, and the number of the two subgroups of the group two were verified and did not. The difference of entropy and uniformity between the filter and the different filter coefficients was not statistically significant (P value was 0.05). The results of Kaplan Mayer survival curve showed that the results of discriminant analysis in the analysis group and the validation group (P value 0.02,0.04) were better than the other parameters. In the certificate group, the P value of RECIST is 0.21 and the P value of the CT value change percentage is 0.49. The P value of the entropy change percentage is 0.47,0.89,0.72,0.73 and 0.58 respectively when the filter and filter coefficient are 1.0,1.5,2.0,2.5, respectively, and the P value of the average evenness change when the filter and the filter coefficient is 1.0,1.5,2.0,2.5 is 0.53,0.72,0.51, respectively. 0.39 and 0.16. conclusions compared with the use of RECIST alone, the imaging parameters before and after treatment include the discriminant analysis of the changes of lesion diameter, CT value, entropy and uniformity, which is more helpful to evaluate the efficacy of antiangiogenic drugs in the treatment of renal carcinoma and lung metastasis.
【作者單位】： 上海交通大學(xué)醫(yī)學(xué)院附屬仁濟(jì)醫(yī)院南院放射科;上海交通大學(xué)醫(yī)學(xué)院附屬仁濟(jì)醫(yī)院放射科;
【基金】：上海交通大學(xué)醫(yī)工交叉研究項(xiàng)目(YG2014MS50) 上海市衛(wèi)生與計(jì)劃生育委員會(huì)科研項(xiàng)目(201540231) 上海自然科學(xué)基金項(xiàng)目(16ZR1420700)資助
【分類號(hào)】：R730.44;R735.2

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