Schmeel Frederic Carsten, Simon Birgit, Luetkens Julian Alexander, Träber Frank, Meyer Carsten, Schmeel Leonard Christopher, Sabet Amir, Ezziddin Samer, Schild Hans Heinz, Hadizadeh Dariusch Reza
Department of Radiology and Radiation Oncology, University Hospital Bonn, Rheinische-Friedrich-Wilhelms-Universität Bonn, Sigmund-Freud-Straße 25, 53127, Bonn, Germany.
Department of Nuclear Medicine, University Hospital Bonn, Rheinische-Friedrich-Wilhelms-Universität Bonn, Bonn, Germany.
J Cancer Res Clin Oncol. 2017 Aug;143(8):1531-1541. doi: 10.1007/s00432-017-2395-5. Epub 2017 Mar 19.
To investigate the clinical potential of pretreatment apparent diffusion coefficient (ADC) on diffusion-weighted magnetic resonance imaging (DWI) for therapy response and outcome prediction in patients with liver-predominant metastatic colorectal cancer (CRC) undergoing radioembolization with Yttrium-microspheres (90Y-RE).
Forty-six consecutive patients with unresectable CRC liver metastases underwent standardized clinical DWI on a 1.5 T MR scanner prior to and 4-6 weeks after 90Y-RE. Pretreatment clinical parameters, ADC values derived from region-of-interest analysis, and the corresponding tumor sizes of three treated liver metastases per subject were recorded. Long-term tumor response to radioembolization was categorized into response (partial remission) and nonresponse (stable disease, progressive disease) according to Response Evaluation Criteria in Solid Tumors v1.1 (RECIST) 3 months after treatment. Associations between long-term tumor response and the clinical and imaging parameters were evaluated. The impact of pretreatment clinical and imaging parameters on progression-free survival (PFS) and overall survival (OS) was further assessed by Kaplan-Meier and multivariate Cox-regression analyses.
Nonresponders had higher hepatic tumor burden (p = 0.021) and lower ADC values than patients responding to 90Y-RE, both pretreatment (986 ± 215 vs. 1162 ± 178; p = 0.036) and posttreatment (1180 ± 350 vs. 1598 ± 225; p = 0.002). ADC values higher than 935 × 10 mm (5 vs. 3 months; p = 0.022) and hepatic tumor burden ≤25% (6 vs. 3 months; p = 0.014) were associated with longer median PFS, whereas ADC >935 × 10 mm (14 vs. 6 months; p = 0.02), hepatic tumor burden ≤25% (14 vs. 6 months; p = 0.048), size of the largest metastasis <4.7 cm (18 vs. 7 months; p = 0.024), and Eastern Cooperative Oncology Group (ECOG) score <1 (8 vs. 5 months; p = 0.045) were associated with longer median OS. On multivariate analysis, ADC >935 × 10 mm and hepatic tumor burden ≤25% remained prognostic factors for PFS, and ADC >935 × 10 mm and size of the largest metastasis <4.7 cm were independent predictors of OS.
Pretreatment ADC on DWI represents a valuable prognostic biomarker for predicting both the therapeutic efficacy and survival prognosis in CRC liver metastases treated by 90Y-RE, allowing risk stratification and potentially optimizing further treatment strategies.
探讨钇微球（90Y-RE）放射性栓塞治疗以肝脏为主的转移性结直肠癌（CRC）患者时，治疗前扩散加权磁共振成像（DWI）表观扩散系数（ADC）对治疗反应和预后预测的临床潜力。
46例不可切除的CRC肝转移患者在90Y-RE治疗前及治疗后4-6周在1.5 T MR扫描仪上接受标准化临床DWI检查。记录治疗前临床参数、通过感兴趣区分析得出的ADC值以及每位受试者三个经治疗肝转移灶的相应肿瘤大小。根据实体瘤疗效评价标准v1.1（RECIST），在治疗后3个月将放射性栓塞的长期肿瘤反应分为反应（部分缓解）和无反应（疾病稳定、疾病进展）。评估长期肿瘤反应与临床及影像参数之间的关联。通过Kaplan-Meier和多变量Cox回归分析进一步评估治疗前临床及影像参数对无进展生存期（PFS）和总生存期（OS）的影响。
与对90Y-RE有反应的患者相比，无反应者的肝肿瘤负荷更高（p = 0.021），ADC值更低，治疗前（986±215 vs. 1162±178；p = 0.036）和治疗后（1180±350 vs. 1598±225；p = 0.002）均如此。ADC值高于935×10⁻³mm²（5个月对3个月；p = 0.022）和肝肿瘤负荷≤25%（6个月对3个月；p = 0.014）与更长的中位PFS相关，而ADC>935×10⁻³mm²（14个月对6个月；p = 0.02）、肝肿瘤负荷≤25%（14个月对6个月；p = 0.048）、最大转移灶大小<4.7 cm（18个月对7个月；p = 0.024）以及东部肿瘤协作组（ECOG）评分<1（8个月对5个月；p = 0.045）与更长的中位OS相关。多变量分析显示，ADC>935×10⁻³mm²和肝肿瘤负荷≤25%仍然是PFS的预后因素，ADC>935×10⁻³mm²和最大转移灶大小<4.7 cm是OS的独立预测因素。
DWI上的治疗前ADC是预测90Y-RE治疗CRC肝转移的治疗效果和生存预后的有价值的预后生物标志物，可进行风险分层并可能优化进一步的治疗策略。
