| Part Ⅰ.Changes of CT imaging and the evaluation value of curative effect before and after immunotherapy combined with chemotherapy in non-small cell lung cancerBackground:According to the data released by the International Cancer Research Institute of the World Health Organization in 2020,lung cancer has dropped to the second place in the world in the incidence rate of cancer,but it is still the malignant tumor with the highest mortality rate.Non small cell lung cancer(NSCLC)is the most common pathological subtype of lung cancer.In recent years,the emergence of immunotherapy has brought revolutionary changes to the treatment plans of patients with advanced tumors and patients with non resectable tumors.However,it is necessary to evaluate the efficacy in a timely manner in order to facilitate clinical adjustment of treatment plans and improve prognosis.A number of studies have confirmed that CT scanning is a repeatable,noninvasive examination that can evaluate the efficacy of tumors through changes in tumor size,density,and enhanced scan characteristics.Currently,there are few related studies on CT findings before and after immunotherapy combined with chemotherapy to evaluate the efficacy.Therefore,the first part of this article aims to analyze the changes of CT images before and after immunotherapy combined with chemotherapy,and explore the application value of CT scanning in evaluating the efficacy of immunotherapy combined with chemotherapy for non small cell lung cancer.Purpose:To explore the application value of CT imaging changes in efficacy evaluation before and after immunotherapy combined with chemotherapy for non small cell lung cancer,and to provide scientific basis for clinical adjustment of treatment plans.Materials and Methods:The clinical and imaging data of 326 patients with pathologically proven non small cell lung cancer who were inoperable or had multiple metastases were collected from the First Affiliated Hospital of Guangdong Pharmaceutical University from January 2019 to September 2022,and 60 patients who met the criteria were eventually included.The patient underwent chest(chest to lung bottom,including the whole lung)plain scan and dual phase enhanced scan using GE Optima 660 64 row multi-slice spiral CT machine.The size of the target lesion,CT values in plain scan and venous phase,and the short diameter of the maximum metastatic lymph node were measured and calculated on a post processing workstation.The parameters of the target lesion and metastatic lymph nodes were statistically analyzed,and the differences between the groups before and after treatment were analyzed using paired t test;Two-variable Spearman correlation analysis was used to calculate the correlation between the two groups.Results:(1)Among the 60 patients,there were 52 males and 8 females,with a male to female ratio of 6.5:1.There were 35 patients aged<60 years old,and 25 patients≥60 years old.(2)After the first treatment,there were 51 cases in the effective group(iCR+iPR+iSD)and 9 cases in the undetermined ineffective group(iUPD);After the second treatment,there were 50 cases in the effective group(iCR+iPR+iSD)and 10 cases in the non effective group(iCPD).After the first treatment,6 patients in the undetermined ineffective group(iUPD)were transferred to the effective group after the second treatment,including 3 iPRs and 3 iSDs;After the first treatment,7 cases of SD were converted to iCPD after the second treatment;After the first treatment,3 cases of iUPD were converted to iCPD after the second treatment,with a treatment effective rate of 83.33%.(3)After the first treatment,the mean CT values of lesions in the effective group and the undetermined ineffective group increased from 31.49±11.65 HU and 33.00±12.62 HU before treatment to 37.75 ± 14.30 HU and 45.11 ± 13.42 HU,respectively,P<0.05.In the effective group after the second treatment,the mean values of plain scan and enhanced CT decreased from 31.46 ± 11.04 HU and 62.64 ± 22.70 HU before treatment to 25.72 ±11.38 HU and 52.00±23.20 HU,respectively,P<0.05.(4)After the first and second treatment,the mean short diameter of metastatic lymph nodes in the effective group decreased from 15.88 ± 10.22 mm and 16.51 ± 10.25 mm before treatment to 12.12 ± 6.92 mm and 10.84 ± 4.98 mm,respectively,P<0.05.(5)After the first treatment,the correlation coefficient between the maximum diameter change of the target lesion and the short diameter change of the lymph node was 0.698,indicating a good correlation;The correlation coefficients between the maximum diameter change of the target lesion and the changes in CT values on plain and enhanced scans,and between the short diameter change of metastatic lymph nodes and the changes in CT values on plain and enhanced scans of the target lesion were lower.(6)After the second treatment,the correlation coefficients between the change in the maximum diameter of the target lesion and the change in the short diameter of the metastatic lymph node,the change in the maximum diameter of the target lesion and the change in the CT value on plain scan,and the change in the short diameter of the metastatic lymph node and the change in the CT value on plain scan of the target lesion were 0.726,0.511,and 0.540,respectively,showing a good correlation.Conclusion:1.Immunotherapy combined with chemotherapy has a significant therapeutic effect on non small cell lung cancer,but there is a possibility of tumor pseudoprogression during the treatment process,and clinical evaluation of the efficacy needs to be cautious..2.Continuous evaluation of the efficacy of immunotherapy combined with chemotherapy for non small cell lung cancer using iRECIST,target lesion plain scan,and enhanced CT values is required,and only one evaluation after treatment cannot accurately reflect the efficacy.Part Ⅱ.Relationship between tumor markers and CT imaging changes before and after immunotherapy combined with chemotherapy in non-small cell lung cancerBackground:There are many reasons for primary enlargement of non small cell lung cancer,such as cytotoxic edema,increased inflammatory response,and tumor progression;If the patient is complicated with basic lung diseases such as bronchiectasis and infection,the focus area will also increase.After immunotherapy,there will be a situation of false progression of the tumor,and judging the progression of the disease based solely on the length of the tumor can easily lead to false positive results.The second part of the article aims to analyze and compare the changes of CT images and serum tumor markers in non small cell lung cancer before and after immunotherapy combined with chemotherapy,and whether there is a certain correlation between the two,and whether the two can complement each other in efficacy evaluation.Purpose:To analyze and compare the changes of CT images and serum tumor markers in non small cell lung cancer before and after immunotherapy combined with chemotherapy,and to explore whether there is a certain correlation between CT efficacy evaluation and serum tumor marker changes,and whether the combination of the two is more accurate in efficacy evaluation.Materials and Methods:The collection was divided into two parts:1.The clinical and imaging data of 60 patients with pathologically confirmed non small cell lung cancer who were inoperable or had multiple metastases were collected from the*hospital from January 2019 to September 2022;2.Collect tumor markers(including CEA,CYFRA21-1,SCC-Ag,and NSE)from the first part of patients before and after two treatments.The patient underwent plain and dual phase enhanced scanning of the chest(from the chest to the lung fundus,including the entire lung)using GE Optima 660 64 row multi-slice spiral CT machine.The parameters of the target lesion and metastatic lymph nodes were measured and calculated at the post processing workstation.The efficacy was evaluated according to the iRECIST standard,and patients were divided into effective groups,undetermined ineffective groups,and ineffective groups.The parameters of the target lesion and metastatic lymph nodes were statistically analyzed with the values of serum tumor markers during the same period.The differences between each group before and after treatment were analyzed using a paired t test.The changes between the two groups were analyzed using a bivariate Spearman correlation analysis to calculate the correlation between the groups.Results:(1)After the first treatment,there were 51 patients in the effective group(iCR+iPR+iSD)and 9 patients in the undetermined ineffective group(iUPD);After the second treatment,there were 50 cases in the effective group(iCR+iPR+iSD)and 10 cases in the non effective group(iCPD).(2)After the first treatment,the mean maximum diameter of the target lesion in the effective group decreased from 47.43 ± 25.00 mm before treatment to 37.63 ± 19.90 mm,P<0.000;The mean maximum diameter of the target lesion in the undetermined ineffective group increased from 39.41 ± 20.09 mm before treatment to 50.00 ± 22.84,P<0.000.After the second treatment,the mean maximum diameter of the target lesion in the effective group decreased from 49.59 ±24.42 mm before treatment to 35.37 ± 21.24 mm,P<0.000;The mean maximum diameter of the target lesion in the ineffective group increased from 29.39 ± 16.13 mm before treatment to 44.3 1 ± 22.77 mm,P=0.004.(3)Before and after the first treatment,there was no statistically significant change in the mean value of CEA in the effective group and the undetermined ineffective group.After the second treatment,the mean CEA in the effective group decreased from 118.77 ± 350.01 ng/ml to 31.25 ± 103.60 ng/ml,P=0.040;There was no statistically significant change in the mean CEA in the ineffective group.(4)The mean value of CYFRA21-1 in the effective group before and after the first and second treatment decreased from 12.36 ± 16.56ng/ml and 14.39 ± 21.04ng/ml to 6.35 ± 7.61ng/ml and 5.87 ± 8.68ng/ml,respectively,P<0.05;There was no statistically significant change in the mean value of CYFRA21-1 in both the undetermined ineffective group and the ineffective group.(5)Before and after the first and second treatment,there was no statistically significant change in the mean value of SCC-Ag in the effective group,the undetermined ineffective group,and the ineffective group.(6)The mean value of NSE in the effective group before and after the first and second treatment decreased from 14.75 ±5.09 ng/ml and 14.90 ± 5.57 ng/ml to 12.93 ± 4.63 ng/ml and 12.34 ± 5.66 ng/ml,respectively,P<0.05;There was no statistically significant change in the mean value of NSE in the undetermined and ineffective groups.(7)After the first treatment,the correlation coefficients between changes in CEA,CYFRA21-1,SCC-Ag,and NSE and changes in the maximum diameter of the target lesion were all lower than 0.5.(8)The correlation coefficient between the change of CYFRA21-1 and the maximum diameter of the target lesion after the second treatment was 0.607,indicating a good correlation;The correlation between changes in CEA,SCC-Ag,and NSE and changes in the maximum diameter of the target lesion is not high.After two treatments,the correlation coefficient between the changes in CEA,CYFRA21-1,SCC-Ag,and NSE and the changes in plain scan CT values and enhanced CT values of the target lesion was lower than 0.5,and there was no significant correlation between them.Conclusion:1.In evaluating the efficacy of immunotherapy combined with chemotherapy in patients with non small cell lung cancer,CYFRA21-1 and NSE are relatively sensitive,with a certain delay in CEA evaluation.2.After immunotherapy combined with chemotherapy for non small cell lung cancer,there was a high correlation between the change in the maximum diameter of the tumor target lesion and the change in CYFRA21-1 value;The method of combining continuous multiple CT findings with changes in serum tumor markers should be used to better evaluate the treatment effect. |
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