Department of Radiology, Shanghai Ninth People's Hospital, Affiliated to JiaoTong University School of Medicine, Number 639, Zhizaoju Road, Shanghai, Huangpu District 200011, China.
Department of Radiology, Shanghai Ninth People's Hospital, Affiliated to JiaoTong University School of Medicine, Number 639, Zhizaoju Road, Shanghai, Huangpu District 200011, China.
Acad Radiol. 2018 Nov;25(11):1433-1438. doi: 10.1016/j.acra.2018.02.017. Epub 2018 Mar 26.
We aimed to investigate the incremental prognostic value of apparent diffusion coefficient (ADC) histogram analysis in patients with head and neck squamous cell carcinoma (HNSCC) and integrate it into a multivariate prognostic model.
A retrospective review of magnetic resonance imaging findings was conducted in patients with pathologically confirmed HNSCC between June 2012 and December 2015. For each tumor, six histogram parameters were derived: the 10th, 50th, and 90th percentiles of ADC (ADC, ADC, and ADC); mean ADC values (ADC); kurtosis; and skewness. The clinical variables included age, sex, smoking status, tumor volume, and tumor node metastasis stage. The association of these histogram and clinical variables with overall survival (OS) was determined. Further validation of the histogram parameters as independent biomarkers was performed using multivariate Cox proportional hazard models combined with clinical variables, which was compared to the clinical model. Models were assessed with C index and receiver operating characteristic curve analyses for the 12- and 36-month OS.
Ninety-six patients were eligible for analysis. Median follow-up was 877 days (range, 54-1516 days). A total of 29 patients died during follow-up (30%). Patients with higher ADC values (ADC > 0.958 × 10 mm/s, ADC > 1.089 × 10 mm/s, ADC > 1.152 × 10 mm/s, ADC > 1.047 × 10 mm/s) and lower kurtosis (≤0.967) were significant predictors of poor OS (P < .100 for all). After adjusting for sex and tumor node metastasis stage, the ADC and kurtosis are both significant predictors of OS with hazard ratios = 1.00 (95% confidence interval: 1.001-1.004) and 0.58 (95% confidence interval: 0.37-0.90), respectively. By adding the ADC parameters into the clinical model, the C index and diagnostic accuracies for the 12- and 36-month OS showed significant improvement.
ADC histogram analysis has incremental prognostic value in patients with HNSCC and increases the performance of a multivariable prognostic model in addition to clinical variables.
我们旨在探讨表观扩散系数（ADC）直方图分析对头颈部鳞状细胞癌（HNSCC）患者的预后价值，并将其纳入多变量预后模型。
回顾性分析 2012 年 6 月至 2015 年 12 月期间经病理证实的 HNSCC 患者的磁共振成像表现。对每个肿瘤，提取了 6 个直方图参数：ADC 的第 10、50 和 90 百分位数（ADC 、ADC 和 ADC ）；平均 ADC 值（ADC ）；峰度；偏度。临床变量包括年龄、性别、吸烟状况、肿瘤体积和肿瘤淋巴结转移分期。确定这些直方图和临床变量与总生存期（OS）的关系。使用多元 Cox 比例风险模型结合临床变量对直方图参数作为独立生物标志物进行进一步验证，并与临床模型进行比较。使用 C 指数和接受者操作特征曲线分析评估 12 个月和 36 个月 OS 的模型。
共有 96 例患者符合分析条件。中位随访时间为 877 天（范围，54-1516 天）。共有 29 例患者在随访期间死亡（30%）。ADC 值较高（ADC ＞0.958×10mm/s、ADC ＞1.089×10mm/s、ADC ＞1.152×10mm/s、ADC ＞1.047×10mm/s）和峰度较低（≤0.967）的患者，OS 较差的显著预测因子（所有 P＜0.010）。在校正性别和肿瘤淋巴结转移分期后，ADC 和峰度均是 OS 的显著预测因子，风险比分别为 1.00（95%置信区间：1.001-1.004）和 0.58（95%置信区间：0.37-0.90）。通过将 ADC 参数添加到临床模型中，12 个月和 36 个月 OS 的 C 指数和诊断准确性均有显著提高。
ADC 直方图分析对头颈部鳞状细胞癌患者具有预后价值，并在临床变量之外提高了多变量预后模型的性能。
