Hou Bob L, Wen Sijin, Katsevman Gennadiy A, Liu Hui, Urhie Ogaga, Turner Ryan C, Carpenter Jeffrey, Bhatia Sanjay
Department of Radiology, West Virginia University, Morgantown, West Virginia, USA.
Department of Biostatistics, West Virginia University, Morgantown, West Virginia, USA.
World Neurosurg. 2019 Apr;124:e285-e295. doi: 10.1016/j.wneu.2018.12.085. Epub 2018 Dec 27.
Many prognostic factors influence overall survival (OS) of patients with glioblastoma. Despite gross total resection and Stupp protocol adherence, many patients have poor survival. Perfusion magnetic resonance imaging may assist in diagnosis, treatment monitoring, and prognostication.
This retrospective study of 36 patients with glioblastoma assessed influence of preoperative magnetic resonance imaging parameters reflecting tumor cell density and vascularity and patient age on OS.
The area under curve based on optimal receiver operating characteristic curves for the perfusion parameters normalized relative tumor blood volume (n_rTBV) and normalized relative tumor blood flow (n_rTBF) were 0.92 and 0.89, respectively, and the highest among all imaging parameters and age. OS showed strongly negative correlations with corrected n_rTBV (R = -0.70; P < 0.001) and n_rTBF (R = -0.67; P < 0.001). The Cox model, which included age and imaging parameters, demonstrated that n_rTBV and n_rTBF were most predictive of OS, with hazard ratios of 5.97 (P = 0.0001) and 8.76 (P = 0.0001), respectively, compared with 1.63 (P = 0.19) for age. Eighteen patients with corrected n_rTBV ≤2.5 (best cutoff value) had a median OS of 15.1 months (95% confidence interval (CI), 11.34-21.25) compared with 2.8 months (95% CI, 1.48-4.03; P < 0.001) for 18 patients with corrected n_rTBV >2.5. Twenty-four patients with n_rTBF ≤2.79 had a median OS of 12 months (95% CI, 10.46-17.9) compared with 2.8 months for 12 patients with n_rTBF >2.79 (95% CI, 1.31-4.2; P < 0.001).
The dominant predictors of OS are normalized perfusion parameters n_rTBV and n_rTBF. Preoperative perfusion imaging may be used as a surrogate to predict glioblastoma aggressiveness and survival independent of treatment.
许多预后因素影响胶质母细胞瘤患者的总生存期（OS）。尽管进行了大体全切并遵循了Stupp方案，但许多患者的生存期仍较差。灌注磁共振成像可能有助于诊断、治疗监测和预后评估。
这项对36例胶质母细胞瘤患者的回顾性研究评估了反映肿瘤细胞密度和血管生成的术前磁共振成像参数以及患者年龄对总生存期的影响。
基于最佳受试者工作特征曲线的灌注参数标准化相对肿瘤血容量（n_rTBV）和标准化相对肿瘤血流（n_rTBF）的曲线下面积分别为0.92和0.89，在所有成像参数和年龄中最高。总生存期与校正后的n_rTBV（R = -0.70；P < 0.001）和n_rTBF（R = -0.67；P < 0.001）呈强烈负相关。包含年龄和成像参数的Cox模型表明，n_rTBV和n_rTBF对总生存期的预测性最强，风险比分别为5.97（P = 0.0001）和8.76（P = 0.0001），而年龄的风险比为1.63（P = 0.19）。校正后n_rTBV≤2.5（最佳临界值）的18例患者的中位总生存期为15.1个月（95%置信区间（CI），11.34 - 21.25），而校正后n_rTBV>2.5的18例患者的中位总生存期为2.8个月（95%CI，1.48 - 4.03；P < 0.
