Chakiba Camille, Cornelis François, Descat Edouard, Gross-Goupil Marine, Sargos Paul, Roubaud Guilhem, Houédé Nadine
Department of Medical Oncology, Bergonié Cancer Institute, Bordeaux, France.
Department of Radiology, Pellegrin Hospital, Bordeaux, France.
Eur J Radiol. 2015 Jun;84(6):1023-8. doi: 10.1016/j.ejrad.2015.02.026. Epub 2015 Mar 6.
To evaluate the performance of dynamic contrast enhanced (DCE) magnetic resonance (MR) imaging to assess the histological response after chemotherapy on bladder carcinoma.
From 2008 to 2010, 12 patients presenting localized urothelial carcinoma of the bladder were prospectively evaluated by DCE-MR imaging before and after two courses of cisplatin-based neoadjuvant chemotherapy. Size and thickness of tumours were measured. Relative enhancement at the arterial (rSI35s) and venous phases (rSI80s) of each tumour was obtained. Histological response was assessed and outcomes were recorded.
Histological examination after neoadjuvant chemotherapy concluded as pathological complete response (pCR) for 6 out of 12 patients. Five patients developed recurrences (4/6 no pCR and 1/6 pCR). Significant differences, between before and after treatment, were found for patients with complete pathological response after chemotherapy for all MR quantitative values. Tumours decreased in size and thickness (both P=0.03). After treatment, rSI80s was significantly different between pCR and non-pCR patients (P=0.04) with a cut-off value of 40%. For this cut-off, sensitivity, specificity and accuracy were 83.33%. Similar recurrence free survivals were obtained if applying the MR cut-off value or the histopathological findings.
Our results suggest that DCE-MR imaging may be a useful biomarker for patients with localized bladder carcinoma, improving selection before surgery.
评估动态对比增强（DCE）磁共振（MR）成像在评估膀胱癌化疗后组织学反应方面的性能。
2008年至2010年，对12例表现为局限性膀胱尿路上皮癌的患者在接受两疗程基于顺铂的新辅助化疗前后进行DCE-MR成像前瞻性评估。测量肿瘤的大小和厚度。获取每个肿瘤在动脉期（rSI35s）和静脉期（rSI80s）的相对增强。评估组织学反应并记录结果。
新辅助化疗后的组织学检查显示12例患者中有6例达到病理完全缓解（pCR）。5例患者出现复发（4/6未达到pCR，1/6达到pCR）。对于化疗后达到完全病理缓解的患者，所有MR定量值在治疗前后均存在显著差异。肿瘤的大小和厚度均减小（P均=0.03）。治疗后，pCR和非pCR患者之间的rSI80s存在显著差异（P=0.04），临界值为40%。以此临界值计算，敏感性、特异性和准确性均为83.33%。应用MR临界值或组织病理学结果可获得相似的无复发生存率。
我们的结果表明，DCE-MR成像可能是局限性膀胱癌患者的一种有用生物标志物，有助于改善手术前的选择。
