Department of Radiology, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
Department of Oncology, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
Can J Neurol Sci. 2019 Sep;46(5):533-539. doi: 10.1017/cjn.2019.225. Epub 2019 Jul 24.
MR perfusion imaging is a relatively new technique that may aid in identifying recurrent tumor (RT) in those with radically treated high-grade gliomas (HGG). We aim to assess the relationship between dynamic susceptibility contrast-enhanced MR perfusion (DSC-MRP) and overall survival to establish a baseline for future research and to determine the utility of DSC-MRP as a clinical decision-making and prognostic tool.
We conducted a retrospective cohort study. Adults with pathologically confirmed HGG at the Juravinski Cancer Centre, Ontario between January 2011 and April 2014 with at least one post-treatment DSC-MRP were included. DSC-MRP was interpreted as positive or negative for tumor recurrence by experienced radiologists. The primary outcome was overall survival.
Sixty-one patients were enrolled. Median survival for patients with a positive DSC-MRP scan was 4.5 months compared with 10.2 months for those with a negative DSC-MRP scan (hazard ratio [unadjusted] = 2.51; 95% confidence interval = 1.10-5.67; p-value = 0.03). Multivariable modeling (adjusted) that included all pre-selected variables showed similar results.
Survival time in patients with HGG is generally low, and almost all patients will demonstrate RT. Our data suggest a positive DSC-MRP correlates with lower overall survival and may signify the presence of highly active RT. These results generate a hypothesis that there may be a prognostic role for the use of serial DSC-MRP for tumor surveillance. More importantly, this biomarker may aid in decision making for treatment plans and palliation.
磁共振灌注成像是一种相对较新的技术，可能有助于识别根治性治疗后的高级别胶质瘤（HGG）患者中的复发性肿瘤（RT）。我们旨在评估动态对比增强磁共振灌注（DSC-MRP）与总生存期之间的关系，为未来的研究建立基线，并确定 DSC-MRP 作为临床决策和预后工具的效用。
我们进行了一项回顾性队列研究。纳入 2011 年 1 月至 2014 年 4 月在安大略省的 Juravinski 癌症中心经病理证实的 HGG 成人患者，且至少有一次治疗后 DSC-MRP。经验丰富的放射科医生对 DSC-MRP 进行解读，判断肿瘤是否复发。主要结局是总生存期。
共纳入 61 例患者。DSC-MRP 扫描阳性患者的中位生存期为 4.5 个月，而 DSC-MRP 扫描阴性患者的中位生存期为 10.2 个月（未调整危险比 [HR] = 2.51；95%置信区间 [CI] = 1.10-5.67；p 值 = 0.03）。纳入所有预先选择的变量的多变量模型（调整后）也得到了相似的结果。
HGG 患者的生存时间普遍较低，几乎所有患者都会出现 RT。我们的数据表明，DSC-MRP 阳性与总生存期较低相关，可能提示存在高度活跃的 RT。这些结果提出了一个假设，即使用连续 DSC-MRP 进行肿瘤监测可能具有预后作用。更重要的是，该生物标志物可能有助于治疗计划和姑息治疗的决策。
