Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, No.5, Fuxing St., Guishan Dist., Tao-Yuan, 333, Taiwan, Republic of China.
Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Tao-Yuan, Taiwan, Republic of China.
J Neurooncol. 2019 Mar;142(1):149-159. doi: 10.1007/s11060-018-03075-x. Epub 2018 Dec 10.
There are no widely accepted MRI markers that predict treatment outcomes of bevacizumab among patients with recurrent glioblastoma (GB). We aimed to determine if conventional MRI features of recurrent GB predict survival of patients receiving bevacizumab.
Patients with recurrent GB were retrospectively included if they received bevacizumab monotherapy between 2008 and 2017 after failure of standard treatment. Their MRI studies obtained at baseline and tumor recurrence, prior to bevacizumab treatment, were evaluated for multiple MRI features including measurable tumor, baseline multicentric tumors, distant recurrence, non-contrast-enhancing tumor, deep white matter invasion, multiple parenchymal tumors, bilateral cerebral involvement, ependymal extension and leptomeningeal dissemination. Predictive values of MRI features and patient characteristics on patient survival were statistically analyzed.
A total of 103 patients were included. Baseline multicentric tumors (OR = 4.07; P = 0.042) and distant recurrence (OR = 28.5; P < 0.001) were two significant predictors of 3-month progression-free survival (PFS) rate. Distant recurrence (HR = 3.94; P < 0.001) was the only independent predictor of PFS. Baseline multicentric tumors (HR = 1.97; P = 0.028), distant recurrence (HR = 4.73; P < 0.001) and leptomeningeal dissemination (HR = 2.28; P = 0.044) were three independent predictors of overall survival.
Baseline multicentric tumors, distant recurrence and leptomeningeal dissemination predicted poor survival among patients receiving bevacizumab for recurrent GB. Conventional MRI may help selecting patients with recurrent GB for bevacizumab treatment.
目前尚无广泛认可的 MRI 标志物可预测复发性胶质母细胞瘤（GB）患者接受贝伐珠单抗治疗的效果。本研究旨在确定复发性 GB 患者的常规 MRI 特征是否可预测接受贝伐珠单抗治疗患者的生存情况。
回顾性纳入 2008 年至 2017 年期间标准治疗失败后接受贝伐珠单抗单药治疗的复发性 GB 患者。对这些患者在接受贝伐珠单抗治疗前的基线和肿瘤复发时的 MRI 研究进行评估，评估的 MRI 特征包括可测量肿瘤、基线多灶性肿瘤、远处复发、非增强肿瘤、深部白质侵犯、多发实质肿瘤、双侧大脑受累、室管膜延伸和软脑膜播散。对 MRI 特征和患者特征对患者生存的预测价值进行统计学分析。
共纳入 103 例患者。基线多灶性肿瘤（OR=4.07；P=0.042）和远处复发（OR=28.5；P<0.001）是 3 个月无进展生存率（PFS）的两个显著预测因素。远处复发（HR=3.94；P<0.001）是 PFS 的唯一独立预测因素。基线多灶性肿瘤（HR=1.97；P=0.028）、远处复发（HR=4.73；P<0.001）和软脑膜播散（HR=2.28；P=0.044）是总生存的三个独立预测因素。
基线多灶性肿瘤、远处复发和软脑膜播散可预测接受贝伐珠单抗治疗的复发性 GB 患者的不良生存情况。常规 MRI 可能有助于选择接受贝伐珠单抗治疗的复发性 GB 患者。
