Pope Whitney B, Kim Hyun J, Huo Jing, Alger Jeffry, Brown Matthew S, Gjertson David, Sai Victor, Young Jonathan R, Tekchandani Leena, Cloughesy Timothy, Mischel Paul S, Lai Albert, Nghiemphu Phioanh, Rahmanuddin Syed, Goldin Jonathan
Department of Radiological Sciences, David Geffen School of Medicine at UCLA Medical Center, 10833 Le Conte Ave, BL-428/CHS, Los Angeles, CA 90095-1721, USA.
Radiology. 2009 Jul;252(1):182-9. doi: 10.1148/radiol.2521081534.
To determine if apparent diffusion coefficient (ADC) histogram analysis can stratify progression-free survival in patients with recurrent glioblastoma multiforme (GBM) prior to bevacizumab treatment.
The study was approved by the institutional review board and was HIPAA compliant; informed consent was obtained. Bevacizumab-treated and control patients (41 per cohort) diagnosed with recurrent GBM were analyzed by using whole enhancing tumor ADC histograms with a two normal distribution mixture fitting curve on baseline (pretreatment) magnetic resonance (MR) images to generate ADC classifiers, including the overall mean ADC as well as the mean ADC from the lower curve (ADC(L)). Overall and 6-month progression-free survival (as defined by the Macdonald criteria) was determined by using Cox proportional hazard ratios and the Kaplan-Meier method with log-rank test.
For bevacizumab-treated patients, the hazard ratio for progression by 6 months in patients with less than versus greater than mean ADC(L) was 4.1 (95% confidence interval: 1.6, 10.4), and there was a 2.75-fold reduction in the median time to progression. For the control patients, there was no significant difference in median time to progression for the patients with low versus high ADC(L) (hazard ratio, 1.8; 95% confidence interval: 0.9, 3.7). For bevacizumab-treated patients, pretreatment ADC more accurately stratified 6-month progression-free survival than did change in enhancing tumor volume at first follow-up (73% vs 58% accuracy, P = .034).
Pretreatment ADC histogram analysis can stratify progression-free survival in bevacizumab-treated patients with recurrent GBM.
确定表观扩散系数（ADC）直方图分析能否在贝伐单抗治疗前对复发性多形性胶质母细胞瘤（GBM）患者的无进展生存期进行分层。
本研究经机构审查委员会批准且符合健康保险流通与责任法案（HIPAA）要求；已获得知情同意。对诊断为复发性GBM的接受贝伐单抗治疗的患者和对照患者（每组41例），利用基线（治疗前）磁共振（MR）图像上具有双正态分布混合拟合曲线的全强化肿瘤ADC直方图进行分析，以生成ADC分类器，包括总体平均ADC以及较低曲线的平均ADC（ADC(L)）。采用Cox比例风险比以及带有对数秩检验的Kaplan-Meier方法确定总体和6个月无进展生存期（根据Macdonald标准定义）。
对于接受贝伐单抗治疗的患者，ADC(L)低于平均值与高于平均值的患者在6个月时进展的风险比为4.1（95%置信区间：1.6, 10.4），中位进展时间减少了2.75倍。对于对照患者，ADC(L)低与高的患者在中位进展时间上无显著差异（风险比，1.8；95%置信区间：0.9, 3.7）。对于接受贝伐单抗治疗的患者，治疗前ADC比首次随访时强化肿瘤体积的变化更准确地对6个月无进展生存期进行分层（准确率分别为73%和58%，P = .034）。
治疗前ADC直方图分析可对接受贝伐单抗治疗的复发性GBM患者的无进展生存期进行分层。
