Supplementary Material for: Clinical Implications of Decreased Computed Tomography Value after Ramucirumab in Advanced Gastric Cancer

<b><i>Objectives:</i></b> This study aimed to evaluate whether a decrease of computed tomography (CT) value for tumors serves as a predictive marker in patients with advanced gastric cancer (aGC) who have undergone chemotherapy with vascular epithelial growth factor receptor 2 inhibitor (ramucirumab). <b><i>Method:</i></b> We retrospectively analyzed 44 patients with aGC who received taxane alone (TAX arm; <i>n</i> = 33), ramucirumab alone, or ramucirumab in combination with taxane (RAM arm; <i>n</i> = 11) as second-line or later chemotherapy between July 2010 and October 2016. In all patients, tumor size and tumor CT value were evaluated at two timepoints: pretreatment and first evaluation. We calculated the change of the tumors’ CT value. The associations of these factors with tumor response, progression-free survival (PFS), and overall survival were investigated. <b><i>Results:</i></b> Ten (90.9%) of 11 patients in the RAM arm and 18 (54.5%) of 33 patients in the TAX arm showed decreased CT values. The rate of CT value change in the RAM arm (median −32.80%, range −53.63 to 6.84%) was higher than that in the TAX arm (median −0.44%, range −37.47 to 40.64%; <i>p</i> = 0.0005). When using the median value of CT value change as a cut-off, PFS was significantly longer in patients with a high rate of CT value change (decrease ≥32.80%) than in those with a low rate (decrease &lt;32.80%) in the RAM arm (median 292 and 112 days; <i>p</i> = 0.045), while no significant difference of this kind was found in the TAX arm (median 91 and 125 days; <i>p</i> = 0.45). <b><i>Conclusions:</i></b> Patients with aGC treated with ramucirumab experienced a significant decrease of CT value of tumors and had an association between the rate of CT value change and PFS. Our study suggests that CT value changes of tumors may be a predictor for the efficacy of ramucirumab in aGC.

<b><i>研究目的：</i></b> 本研究旨在评估肿瘤计算机断层扫描（CT）值下降是否可作为接受血管内皮生长因子受体2抑制剂（雷莫芦单抗，ramucirumab）化疗的晚期胃癌（aGC）患者的预测标志物。<b><i>方法：</i></b> 我们于2010年7月至2016年10月期间，回顾性分析了44例接受二线及以上化疗的晚期胃癌（aGC）患者，其中分为单用紫杉类药物组（TAX组；<i>n</i> = 33）、单用雷莫芦单抗或雷莫芦单抗联合紫杉类药物组（RAM组；<i>n</i> = 11）。所有患者均在治疗前及首次疗效评估两个时间点评估肿瘤大小与肿瘤CT值，并计算肿瘤CT值的变化率。本研究探讨了上述指标与肿瘤应答、无进展生存期（progression-free survival, PFS）及总生存期的相关性。<b><i>结果：</i></b> RAM组11例患者中10例（90.9%）出现肿瘤CT值下降，TAX组33例患者中18例（54.5%）出现肿瘤CT值下降。RAM组CT值变化率的中位数为-32.80%（范围：-53.63%~6.84%），显著高于TAX组的中位数-0.44%（范围：-37.47%~40.64%；<i>p</i> = 0.0005）。当以CT值变化率的中位数作为截点时，RAM组中CT值下降率≥32.80%的患者无进展生存期显著长于下降率<32.80%的患者（中位生存期分别为292天与112天；<i>p</i> = 0.045）；而TAX组未观察到此类显著差异（中位生存期分别为91天与125天；<i>p</i> = 0.45）。<b><i>结论：</i></b> 接受雷莫芦单抗治疗的晚期胃癌（aGC）患者肿瘤CT值出现显著下降，且CT值变化率与无进展生存期存在关联。本研究提示，肿瘤CT值变化可作为晚期胃癌患者接受雷莫芦单抗治疗疗效的预测指标。