Department of Radiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
Biomed Res Int. 2020 Sep 26;2020:3268138. doi: 10.1155/2020/3268138. eCollection 2020.
The accurate prediction of prognosis is key to prompt therapy adjustment. The purpose of our study was to investigate the efficacy of diffusion kurtosis imaging (DKI) in predicting progression-free survival (PFS) and overall survival (OS) in osteosarcoma patients with preoperative chemotherapy.
Thirty patients who underwent DKI before and after chemotherapy, followed by tumor resection, were retrospectively enrolled. The patients were grouped into good responders (GRs) and poor responders (PRs). The Kaplan-Meier and log-rank test were used for survival analysis. The association between the DKI parameters and OS and PFS was performed by univariate and multivariate Cox proportional hazards models.
Significantly worse OS and PFS were associated with a lower mean diffusivity (MD) after chemotherapy (HR, 5.8; 95% CI, 1.5-23.1; = 0.012 and HR, 3.5; 95% CI, 1.2-10.1: = 0.028, respectively) and a higher mean kurtosis (MK) after chemotherapy (HR, 0.3; 95% CI, 0.1-0.9; = 0.041 and HR, 0.3; 95% CI, 0.1-0.8; = 0.049, respectively). Likewise, shorter OS and PFS were also significantly associated with a change rate in MD (CR MD) of less than 13.53% (HR, 8.6; 95% CI, 1.8-41.8; = 0.007 and HR, 2.9; 95% CI, 1.0-8.2; = 0.045, respectively). Compared to GRs, PRs had an approximately 9- and 4-fold increased risk of death (HR, 9.4; 95% CI, 1.2-75; = 0.034) and progression (HR, 4.2; 95% CI, 1.2-15; = 0.026), respectively.
DKI has a potential to be a prognostic tool in osteosarcoma. Low MK and high MD after chemotherapy or high CR MD indicates favorite outcome, while prospective studies with large sample sizes are warranted.
准确预测预后是及时调整治疗的关键。我们的研究目的是探讨扩散峰度成像（DKI）在预测接受术前化疗的骨肉瘤患者无进展生存期（PFS）和总生存期（OS）中的疗效。
回顾性纳入 30 例接受化疗前后 DKI 检查并随后进行肿瘤切除的患者。将患者分为完全缓解者（GRs）和部分缓解者（PRs）。采用 Kaplan-Meier 和对数秩检验进行生存分析。采用单因素和多因素 Cox 比例风险模型分析 DKI 参数与 OS 和 PFS 的相关性。
化疗后平均弥散度（MD）降低（HR，5.8；95%CI，1.5-23.1； = 0.012）和化疗后平均峰度（MK）升高（HR，0.3；95%CI，0.1-0.9； = 0.041）与更差的 OS 和 PFS 显著相关。同样，较短的 OS 和 PFS 也与 MD 的变化率（CR MD）小于 13.53%（HR，8.6；95%CI，1.8-41.8； = 0.007）和 HR，2.9；95%CI，1.0-8.2； = 0.045）显著相关。与 GRs 相比，PRs 的死亡风险（HR，9.4；95%CI，1.2-75； = 0.034）和进展风险（HR，4.2；95%CI，1.2-15； = 0.026）分别增加约 9 倍和 4 倍。
DKI 有可能成为骨肉瘤的一种预后工具。化疗后低 MK 和高 MD 或高 CR MD 提示预后较好，需要进一步进行大样本量的前瞻性研究。
