论文标题

一种用于响应治疗的肿瘤变化的高精度评估的新方法

A New Method for the High-Precision Assessment of Tumor Changes in Response to Treatment

论文作者

Tar, P. D., Thacker, N. A., O'Connor, J. P. B.

论文摘要

成像表明临床前和人类肿瘤是异质性的,即单个肿瘤可以表现出多个区域,在正常发育过程中均表现出不同的行为,并且对治疗的反应也有所不同。在对照组肿瘤中观察到的较大变化会掩盖由于归因于变化原因的歧义而导致的显着治疗作用的检测。由于实验设计的限制,这可能会阻碍有效疗法的发展,而不是由于治疗衰竭。描述了对成像信号中生物变异和异质性进行建模的改进方法。具体而言,线性泊松建模(LPM)在放疗前和72小时之前评估了两种结直肠癌的异种移植模型,在放疗前和72小时后评估了明显扩散的共有效效率(ADC)。使用基本ADC分布参数的常规t检验分析,将测量变化的统计意义与可实现的变化的统计学意义进行了比较。当LPM应用于治疗的肿瘤时,LPM检测到了高度显着的变化。与常规方法相比,所有肿瘤的分析对于所有肿瘤都是显着的,等于4倍的功率(即等同于样本量大16倍)。相比之下,只有使用t检验在队列水平上检测到高度显着的变化,从而限制了其在个性化医学中的潜在用途,并增加了测试过程中所需的动物数量。此外,LPM使得为每个异种移植模型估算响应和非反应组织的相对体积。对处理过的异种移植物的剩余分析提供了质量控制并确定了潜在的异常值,从而提高了对临床相关样本量的LPM数据的信心。

Imaging demonstrates that preclinical and human tumors are heterogeneous, i.e. a single tumor can exhibit multiple regions that behave differently during both normal development and also in response to treatment. The large variations observed in control group tumors can obscure detection of significant therapeutic effects due to the ambiguity in attributing causes of change. This can hinder development of effective therapies due to limitations in experimental design, rather than due to therapeutic failure. An improved method to model biological variation and heterogeneity in imaging signals is described. Specifically, Linear Poisson modelling (LPM) evaluates changes in apparent diffusion co-efficient (ADC) before and 72 hours after radiotherapy, in two xenograft models of colorectal cancer. The statistical significance of measured changes are compared to those attainable using a conventional t-test analysis on basic ADC distribution parameters. When LPMs were applied to treated tumors, the LPMs detected highly significant changes. The analyses were significant for all tumors, equating to a gain in power of 4 fold (i.e. equivelent to having a sample size 16 times larger), compared with the conventional approach. In contrast, highly significant changes are only detected at a cohort level using t-tests, restricting their potential use within personalised medicine and increasing the number of animals required during testing. Furthermore, LPM enabled the relative volumes of responding and non-responding tissue to be estimated for each xenograft model. Leave-one-out analysis of the treated xenografts provided quality control and identified potential outliers, raising confidence in LPM data at clinically relevant sample sizes.

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