Wang Congxiao, Xu Zhijian, Wang Song, Peng Lijing, Zhang Wei, Li Xueda, Yang Lili, Luan Ying, Su Tao, Li Zixiang, Hu Xiaokun
Department of the Interventional Medical Center, the Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong, China.
JinHua Municipal Central Hospital, JinHua, 321000, Zhejiang, China.
J Cancer. 2021 Jan 30;12(7):1945-1951. doi: 10.7150/jca.50789. eCollection 2021.
To determine whether the minimum apparent diffusion coefficient (minADC) value can stratify survival in patients with glioma before I brachytherapy. The study was approved by the Institutional Review Board, and the requirement for informed consent was waived. Twenty-three patients (16 male, 7 female; median age, 48 years) with high-grade glioma (HGG) (n=9) or recurrence after multimodal treatment (n=14) were included in this study. minADC values were obtained before I implantation. Overall survival (OS) and progression-free survival (PFS) were analyzed with Cox proportional hazards regression models and the Kaplan-Meier method with the log-rank test. For I-treated patients, the hazard ratio for OS in patients with ADC≥1.010^ mm·sec (high minADC) versus ADC<1.010^ mm·sec (low minADC) was 0.220 (95% confidence interval: 0.066, 0.735). The median OS was 12 months for patients with high minADC values and 6.0 months for those with low minADC values, and the differences were significant (p=0.032). The median PFS was 12 months for patients with high minADC values and 4 months for those with low minADC values. Significant differences were found in the long-rank test (p=0.013). The multivariate analysis results showed that minADC pre-I implantation was an independent predictor of OS and PFS in patients receiving I brachytherapy. Pre-I implantation ADC analysis can stratify prognosis in I-treated patients with glioma, which may aid in choosing a suitable therapy for glioma patients.
为了确定最小表观扩散系数（minADC）值能否在胶质瘤患者近距离放射治疗前对生存情况进行分层。本研究经机构审查委员会批准，且豁免了知情同意的要求。本研究纳入了23例高级别胶质瘤（HGG）患者（9例）或多模式治疗后复发的患者（14例）（16例男性，7例女性；中位年龄48岁）。在植入碘-125粒子前获取minADC值。采用Cox比例风险回归模型以及带有对数秩检验的Kaplan-Meier方法分析总生存期（OS）和无进展生存期（PFS）。对于接受碘-125粒子治疗的患者，ADC≥1.0×10⁻³mm²·sec（高minADC）的患者与ADC<1.0×10⁻³mm²·sec（低minADC）的患者相比，OS的风险比为0.220（95%置信区间：0.066，0.735）。minADC值高的患者中位OS为12个月，minADC值低的患者为6.0个月，差异具有统计学意义（p = 0.032）。minADC值高的患者中位PFS为12个月，minADC值低的患者为4个月。对数秩检验发现差异具有统计学意义（p = 0.013）。多因素分析结果显示，碘-125粒子植入前的minADC是接受碘-125粒子近距离放射治疗患者OS和PFS的独立预测因素。碘-125粒子植入前的ADC分析可以对接受碘-125粒子治疗的胶质瘤患者的预后进行分层，这可能有助于为胶质瘤患者选择合适的治疗方法。
