Cao Yue, Nagesh Vijaya, Hamstra Daniel, Tsien Christina I, Ross Brian D, Chenevert Thomas L, Junck Larry, Lawrence Theodore S
Departments of Radiation Oncology, University of Michigan, Ann Arbor, MI 48109-0010, USA.
Cancer Res. 2006 Sep 1;66(17):8912-7. doi: 10.1158/0008-5472.CAN-05-4328.
Magnetic resonance imaging reveals heterogeneous regions within high-grade gliomas, such as a contrast-enhanced rim, a necrotic core, and non-contrast-enhanced abnormalities. It is unclear which of these regions best describes tumor aggressiveness. We hypothesized that the vascular leakage volume, reflecting disorganized angiogenesis typical of glioblastoma, would be a strong predictor of clinical outcome. The FLAIR tumor volume, post-gadolinium T1 tumor volume, tumor vascular leakage volume determined by dynamic contrast-enhanced imaging, and volume of the contrast-enhanced rim seen on post-gadolinium T1-weighted images were defined for 20 patients about to undergo treatment for newly diagnosed high-grade gliomas. The potential for imaging characteristics to improve prediction of survival and time to progression over clinical variables was tested by using Cox regression analysis. Single-variable Cox regression analysis of each of the four tumor subvolumes revealed that the vascular leakage volume was the only significant predictor of survival. When the joint effect of clinical variables and the vascular leakage volume were tested for prediction of survival, only the age and the vascular leakage volume were selected as significant predictors. However, when time to progression was tested as a dependent variable, both the vascular leakage volume and the vascular permeability were selected as copredictors, along with surgical status. Our findings suggest that for patients with high-grade glioma, time to progression after radiation therapy is influenced by both underlying biological aggressiveness (vascularity) and volume of aggressive tumor. In contrast, survival depends chiefly on the volume of aggressive tumor at the time of presentation.
磁共振成像显示高级别胶质瘤内存在异质性区域，如强化边缘、坏死核心和无强化异常区。目前尚不清楚这些区域中哪一个最能描述肿瘤的侵袭性。我们假设，反映胶质母细胞瘤典型的紊乱血管生成的血管渗漏量，将是临床预后的有力预测指标。为20例即将接受新诊断高级别胶质瘤治疗的患者定义了液体衰减反转恢复序列（FLAIR）肿瘤体积、钆剂增强后T1加权像肿瘤体积、通过动态对比增强成像测定的肿瘤血管渗漏量以及钆剂增强后T1加权像上所见的强化边缘体积。通过Cox回归分析检验了成像特征相较于临床变量改善生存和疾病进展时间预测的潜力。对四个肿瘤子体积分别进行单变量Cox回归分析显示，血管渗漏量是生存的唯一显著预测指标。当检验临床变量和血管渗漏量对生存的联合效应时，仅年龄和血管渗漏量被选为显著预测指标。然而，当将疾病进展时间作为因变量进行检验时，血管渗漏量和血管通透性与手术状态一起被选为共同预测指标。我们的研究结果表明，对于高级别胶质瘤患者，放疗后的疾病进展时间受潜在生物学侵袭性（血管生成）和侵袭性肿瘤体积的影响。相比之下，生存主要取决于就诊时侵袭性肿瘤的体积。
