Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 43 Olympic-ro 88, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea.
Department of Neurosurgery, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea.
BMC Cancer. 2021 Jun 1;21(1):654. doi: 10.1186/s12885-021-08414-2.
Updated response assessment in neuro-oncology (RANO) does not consider peritumoral non-enhancing lesion (NEL) and baseline (residual) contrast enhancement (CE) volume. The objective of this study is to explore helpful imaging characteristics to refine RANO for assessing early treatment response (pseudoprogression and time-to-progression [TTP]) in patients with IDH wild-type glioblastoma.
This retrospective study enrolled 86 patients with IDH wild-type glioblastoma who underwent consecutive MRI examinations before and after concurrent chemoradiotherapy (CCRT). NEL was classified as edema- or tumor-dominant type on pre-CCRT MRI. CE evolution was categorized into 4 patterns based on post-operative residual CE (measurable vs. non-measurable) and CE volume change (same criteria with RANO) during CCRT. Multivariable logistic regression, including clinical parameters, NEL type, and CE evolution pattern, was used to analyze pseudoprogression rate. TTP and OS according to NEL type and CE evolution pattern was analyzed by the Kaplan-Meier method.
Pseudoprogression rate was significantly lower (chi-square test, P = .047) and TTP was significantly shorter (hazard ratio [HR] = 2.03, P = .005) for tumor-dominant type than edema-dominant type of NEL. NEL type was the only predictive marker of pseudoprogression on multivariate analysis (odds ratio = 0.26, P = .046). Among CE evolution patterns, TTP and OS was shortest in patients with residual CE compared with those exhibiting new CE (HR = 4.33, P < 0.001 and HR = 3.71, P = .009, respectively). In edema-dominant NEL type, both TTP and OS was stratified by CE evolution pattern (log-rank, P = .001), whereas it was not in tumor-dominant NEL.
NEL type improves prediction of pseudoprogression and, together with CE evolution pattern, further stratifies TTP and OS in patients with IDH wild-type glioblastoma and may become a helpful biomarker for refining RANO.
神经肿瘤学中的更新反应评估（ RANO ）不考虑瘤周非增强病变（ NEL ）和基线（残留）对比增强（ CE ）体积。本研究的目的是探讨有助于完善 RANO 评估 IDH 野生型胶质母细胞瘤患者早期治疗反应（假性进展和进展时间[ TTP ]）的影像学特征。
本回顾性研究纳入了 86 例 IDH 野生型胶质母细胞瘤患者，这些患者在同步放化疗（ CCRT ）前后均接受了连续 MRI 检查。在 CCRT 前的 MRI 上，根据水肿或肿瘤优势将 NEL 分为优势型。根据术后残留 CE 的（可测量与不可测量）和 CCRT 期间 CE 体积变化（与 RANO 相同的标准），将 CE 演变分为 4 种类型。包括临床参数、NEL 类型和 CE 演变模式的多变量逻辑回归用于分析假性进展率。根据 NEL 类型和 CE 演变模式，采用 Kaplan-Meier 方法分析 TTP 和 OS 。
与水肿优势型 NEL 相比，肿瘤优势型 NEL 的假性进展率显著降低（卡方检验， P = .047 ）， TTP 显著缩短（风险比[ HR ] = 2.03 ， P = .005 ）。在多变量分析中， NEL 类型是假性进展的唯一预测标志物（优势比 = 0.26 ， P = .046 ）。在 CE 演变模式中，与出现新 CE 的患者相比，残留 CE 的患者 TTP 和 OS 最短（ HR = 4.33 ， P < .001 和 HR = 3.71 ， P = .009 ）。在水肿优势型 NEL 中， TTP 和 OS 均根据 CE 演变模式分层（对数秩检验， P = .001 ），而在肿瘤优势型 NEL 中则不然。
NEL 类型提高了对假性进展的预测能力，并且与 CE 演变模式一起，进一步分层了 IDH 野生型胶质母细胞瘤患者的 TTP 和 OS ，并可能成为完善 RANO 的有用生物标志物。
