The Study Of Correlation Between Tumor Growth Rate And Clinicopathological Features As Well As Its Value In Early Efficacy Evaluation Of Neuroendocrine Neoplasm

Part 1 Correlation between Tumor Growth Rate and Clinicopathological Features in Neuroendocrine Neoplasm[Objective]The highly heterogeneous characteristics of neuroendocrine neoplasm(NEN)poses particular challenges in clinical treatment processes.Tumor growth rate(TGR)represents the percentage change in tumor volume per month(%/m),which can provide quantitative information of the tumor kinetics through tumor size changes over time.The present study aims to analyze the correlation between TGR3m(defined as the tumor growth rate after 3 months of initial treatment)and clinicopathological features of NEN,and to discuss its potential clinical value.[Materials and Methods]Patients with pathologically diagnosed NEN who treated at Chinese Academy of Medical Sciences Cancer Hospital from January 2010 to December 2018 were enrolled in this retrospective analysis.The clinicopathological data were collected,including age,gender,family history of tumor,location of primary tumor,histological grade,Ki-67 index,clinical stage,distant metastasis and first-line treatment;TGR3m was calculated by comparing the multiphase enhanced CT or MR imaging at baseline and 3 months after treatment.Receiver operating characteristic curve analysis was used to determine the optimal cut-off values of TGR3m for predicting progression-free survival.The optimal cut-off values was used to divide the enrolled patients into the two categories,and analyzes the correlation between TGR3m and the clinicopathological characteristics of NEN patients.[Results]Thirty patients,16 men and 14 women,were included in the study.ROC curve analysis showed that the area under curve(AUC)of TGR3m for PFS prediction was 0.921(95%CI=0.824-0.999,P<0.001),and the optimal cutoff value was-5.8%/m(sensitivity was 88.89%,specificity was 91.67%).Patients were divided based on the optimal cut-off,including 17 patients with TGR3m≥-5.8%/m and 13 patients with TGR3m<-5.8%/m;The result indicated that TGR3m was correlated with the location of primary tumor(P=0.002),histological grade(P=0.009),clinical stage(P=0.003)and distant metastasis(P=0.003).[Conclusions]TGR3m,a radioactive biomarker that can reflect tumor growth dynamics,is related to the primary site,histological grade,clinical stage and distant metastasis of NEN.In addition,TGR3m could indirectly reflect the biological behavior of tumor.It is easy to obtain in clinical practice and has potential clinical value.Part 2 Value of Tumor Growth Rate in the Early Evaluation of Therapeutic Efficacy in Neuroendocrine Neoplasm[Objective]It is a recognized clinical problem that the international widely used RECIST has limitations in the field of NEN.Tumor growth rate(TGR)is considered to be an early radiological biomarker to overcome the limitations of RECIST in many other tumor fields.The present study aims to explore the potential clinical value of TGR3m in the early efficacy evaluation of NEN and to predict the prognosis of patients[Materials and Methods]Patients with pathologically diagnosed NEN who treated at Chinese Academy of Medical Sciences Cancer Hospital from January 2010 to December 2018 were enrolled in this retrospective analysis.Patients were divided based on the optimal cutoff of-5.8%/m(TGR3m≥-5.8%/m vs<-5.8%/m).The end point of follow-up observation was progression-free survival(PFS).The cumulative progress rate of patients in the two groups was calculated by Kaplan-Meier method,and the survival curve was drawn.Log-rank test was used for comparison between groups;The efficacy of patients 3 months after treatment were assessed according to the RECIST standard to evaluate,the patients assessed as stable disease(SD)were further divided into groups by TGR3m,and the difference in survival between the two groups was analyzed by the Kaplan-Meier method;In the overall population and SD population,the COX risk proportional regression model was used to analyze the value of TGR3m for predicting PFS in single-factor and multi-factor analysis.[Results]Thirty patients,including 17 patients with TGR3m ≥-5.8%/m and 13 patients with TGR3m<-5.8%/m,were included in the study.Patients with TGR3m≥-5.8%/m had a higher risk of progression in either the general population(HR:13.06.95%CI:3.21-50.08,P<0.001)or the SD population(HR:15.55,95%CI:2.64-91.55,P=0.002),and there was a difference in progression-free survival between the two groups;Multivariate Cox regression analysis showed that TGR3m ≥-5.8%/m(HR=10.906,95%CI:1.953-60.898,P=0.006),NEC of histological grade(HR=9.30,95%CI:1.203,71.893,P=0.033)was an independent risk factor affecting the prognosis of NEN patients.[Conclusions]TGR3m has the ability to identify NEN patients who respond to treatment at an early stage and predict PFS.Furthermore,it is easy to obtain in clinical practice and is an index with potential clinical value.