Blood Volume as a new functional image-based biomarker of progression in\xa0metastatic renal cell carcinoma

Aska Drljevic-Nielsen,Frede Donskov,Jill Rachel Mains,Finn Rasmussen,Kennet Thorup

doi:10.1038/s41598-021-99122-1

Abstract

RECIST v1.1 has limitations in evaluating progression. We assessed Dynamic Constrast Enhanced Computed Tomography (DCE-CT) identified Blood Volume (BV) for the evaluation of progressive disease (PD) in patients with metastatic renal cell carcinoma (mRCC). BV was quantified prospectively at baseline, after one month, then every three months until PD. Relative changes (ΔBV) were assessed at each timepoint compared with baseline values. The primary endpoint was Time to PD (TTP), the secondary endpoint was Time to the scan prior to PD (PDminus1). Cox proportional hazard models adjusted ΔBV for treatments and International mRCC Database Consortium factors. A total of 62 patients had analyzable scans at the PD timepoint. Median BV was 23.92 mL × 100 g−1 (range 4.40–399.04) at PD and 26.39 mL × 100 g−1 (range 8.70–77.44) at PDminus1. In the final multivariate analysis higher ΔBV was statistically significantly associated with shorter Time to PD, HR 1.11 (95% CI 1.07–1.15, P < 0.001). Also assessed at PDminus1, higher ΔBV was significantly associated with shorter time to PD, HR 1.14 (95% CI 1.01–1.28, P = 0.031). In conclusion, DCE-CT identified BV is a new image-based biomarker of therapy progression in patients with mRCC.

Highlights

RECIST v1.1 has limitations in evaluating progression
When monitoring treatment according to RECIST v1.1, an enlargement in the tumor can lead to interpretational distress over stopping therapy, as the patient may not necessarily have treatment failure
These data can be used to calculate functional parameters, such as blood volume (BV) using histogram analysis. This parameter correlates to vascularity and provides additional information to the morphological information obtained from the routine Contrast-Enhanced CT (CE-CT)[10,11,12]

Summary

Introduction

We assessed Dynamic Constrast Enhanced Computed Tomography (DCE-CT) identified Blood Volume (BV) for the evaluation of progressive disease (PD) in patients with metastatic renal cell carcinoma (mRCC). DCE-CT identified BV is a new image-based biomarker of therapy progression in patients with mRCC. Dynamic contrast-enhanced computed tomography (DCE-CT) is a functional imaging modality consisting of repeated scans over a single target lesion (primary tumor or metastases) enabling an assessment of changes in contrast enhancement of the scanned tissue. DCT-CT identified BV at baseline was recently identified as a new, independent prognostic factor in patients with metastatic renal cell carcinoma (mRCC), that may add to the prognostic accuracy of International Metastatic renal cell carcinoma Database Consortium (IMDC) c riteria[13,14]. Even though it is well established that a high baseline BV was an independent

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Conclusion