表观扩散系数和肿瘤体积测量有助于对接受贝伐单抗治疗的复发性多形性胶质母细胞瘤患者的无进展生存期进行分层。
Apparent diffusion coefficient and tumor volume measurements help stratify progression-free survival of bevacizumab-treated patients with recurrent glioblastoma multiforme.
作者信息
Buemi Francesco, Guzzardi Giuseppe, Del Sette Bruno, Sponghini Andrea P, Matheoud Roberta, Soligo Eleonora, Trisoglio Alessandra, Carriero Alessandro, Stecco Alessandro
机构信息
1 Radiology Department, "Papardo" Hospital, Messina, Italy.
2 Radiology Department, University of Eastern Piedmont, "Maggiore della Carità" Hospital, Novara, Italy.
出版信息
Neuroradiol J. 2019 Aug;32(4):241-249. doi: 10.1177/1971400919847184. Epub 2019 May 8.
BACKGROUND
The aim of this study was to determine whether apparent diffusion coefficient (ADC) bi-component curve-fitting histogram analysis and volume percentage change (VPC) prior to bevacizumab treatment can stratify progression-free survival (PFS) and overall survival (OS) in patients with glioblastoma multiforme (GBM) on first recurrence.
METHODS
We retrospectively evaluated 17 patients with recurrent GBM who received bevacizumab and fotemustine ( = 13) or only bevacizumab ( = 4) on first recurrence at our institution between December 2009 and July 2015. Both T2/FLAIR abnormalities and enhancing tumor on T1 images were mapped to the ADC images. ADC-L and ADC-M values were obtained trough bi-Gaussian curve fitting histogram analysis. Furthermore, the study population was dichotomized into two subgroups: patients displaying a reduction in enhancing tumor volume of either >55% or <55% between the mean value calculated at baseline and first follow-up. Subsequently, a second dichotomization was performed according to a reduction in the T2 / FLAIR volume >41% or <41% at first check after treatment. OS and PFS were assessed using volume parameters in a Cox regression model adjusted for significant clinical parameters.
RESULTS
In univariate analysis, contrast-enhanced (CE)-ADC-L was significantly predictive of PFS ( = 0.01) and OS ( = 0.03). When we dichotomized our sample using the 55% cut-off for enhancing tumor volume, CE-VPC was able to predict PFS ( = 0.01) but not OS ( = 0.08). In multivariate analysis, only the CE-ADC-L was predictive of PFS ( = 0.01), albeit not predictive of OS ( = 0.14). CE-ADC-M, T2/FLAIR-ADC-L, T2/FLAIR-ADC, and T2/FLAIR VPC were not significantly predictive of PFS and OS ( > 0.05) in both univariate and multivariate analysis.
CONCLUSIONS
CE-ADC and CE-VPC can stratify PFS for patients with recurrent glioblastoma prior to bevacizumab treatment.
背景
本研究旨在确定在贝伐单抗治疗前，表观扩散系数（ADC）双组分曲线拟合直方图分析和体积百分比变化（VPC）是否能够对多形性胶质母细胞瘤（GBM）首次复发患者的无进展生存期（PFS）和总生存期（OS）进行分层。
方法
我们回顾性评估了2009年12月至2015年7月期间在我院首次复发时接受贝伐单抗和福莫司汀（n = 13）或仅接受贝伐单抗（n = 4）治疗的17例复发性GBM患者。将T2/FLAIR异常和T1图像上的强化肿瘤均映射到ADC图像上。通过双高斯曲线拟合直方图分析获得ADC-L和ADC-M值。此外，将研究人群分为两个亚组：在基线和首次随访时计算的平均值之间，强化肿瘤体积减少>55%或<55%的患者。随后，根据治疗后首次检查时T2/FLAIR体积减少>41%或<41%进行第二次二分法。在调整了显著临床参数的Cox回归模型中，使用体积参数评估OS和PFS。
结果
在单变量分析中，对比增强（CE）-ADC-L对PFS（P = 0.01）和OS（P = 0.03）具有显著预测性。当我们使用55%的强化肿瘤体积临界值对样本进行二分法时，CE-VPC能够预测PFS（P = 0.01），但不能预测OS（P = 0.08）。在多变量分析中，只有CE-ADC-L对PFS具有预测性（P = 0.01），尽管对OS没有预测性（P = 0.14）。在单变量和多变量分析中，CE-ADC-M、T2/FLAIR-ADC-L、T2/FLAIR-ADC和T2/FLAIR VPC对PFS和OS均无显著预测性（P>0.05）。
结论
CE-ADC和CE-VPC能够对贝伐单抗治疗前的复发性胶质母细胞瘤患者的PFS进行分层。
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