Baseline CT scans prior to initiation of therapy were retrospectively reviewed by a board certified radiologist with expertise in oncologic imaging. All measurable lesions in each patient Ixazomib purchase were selected, regardless of the number of lesions Inhibitors,Modulators,Libraries in total or per organ, in order to evaluate het erogeneity among lesions within the same patient. The exception included 2 patients with innumerable lesions in one organ, in whom the largest 5 lesions within the organ were selected, in addition to all the measurable lesions in other organs. The diameters and density were measured for all lesions on contrast enhanced CT images on baseline scans and on the first follow up scans. Diameters were measured using a caliper type measurement tool on PACS workstation.
Inhibitors,Modulators,Libraries The CT attenuation was measured using an oval region of interest covering the maximum area of each lesion excluding the surrounding structures. Three lesions demon strated 0 HU at baseline due to partial volume effects, which were ineligible for the study and excluded. Diameter and density changes on follow up The percent changes of diameter and CT density were calculated on the follow up scan in reference to the baseline. For CT density, the absolute Inhibitors,Modulators,Libraries change was also calculated. For lesion based analysis, the diameter and density measurements of each lesion were used. For patient based analysis, the sum of the diame ters and the average of CT density were used to repre sent baseline and follow up measurements, for those who had 5 lesions in total and 2 lesions per organ, up to 5 largest lesions in total and up to 2 largest lesions per organ were chosen according to RECIST1.
1, based on the baseline measurements. Response was assigned for each lesion and each pa tient, based on RECIST, MASS and Choi Inhibitors,Modulators,Libraries criteria. Measurement variability To assess measurement variability, two board certified radiologists independently measured the diameter and density of all lesions on baseline scans, without access to other radiologists measurements, as described previously. Radiologist 1 performed mea surements twice with one week interval, without access to the prior measurements. Statistical analysis Descriptive methods were used to summarize patient demographic and disease characteristics. Measurements on a continuous scale were summarized using mean, median, standard deviation, and range.
Categorical char acteristics were summarized using percentages and 95% exact binomial confidence intervals. The distributions of progression free survival and overall survival were assessed using the product limit method of Kaplan Meier, with 95% confidence Inhibitors,Modulators,Libraries intervals estimated using log methodology. To investigate the as sociation between baseline diameter density and outcome, PFS definitely and OS were compared between 2 groups dichoto mized at the median baseline diameter or density. Cox proportional hazards models were used to estimate hazard ratios and 95% confidence intervals.