UCLA Brain Tumor Imaging Laboratory (BTIL), Center for Computer Vision and Imaging Biomarkers, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.
Deptartment of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.
J Neurooncol. 2022 Sep;159(3):509-518. doi: 10.1007/s11060-022-04088-3. Epub 2022 Jul 17.
Pseudoprogression (PsP) remains an elusive and clinically important, yet ill-defined, phenomena that, generally, involves a period of early radiographic progression (enhancement) followed by a period of radiographic stability or regression. In the current study, we utilized data from the control arm of a phase III clinical trial in newly-diagnosed glioblastoma to explore imaging characteristics of "clinically-defined PsP", or early radiographic progression (PFS < 6 months from chemoradiation) followed by a long post-progression residual overall survival (ROS > 12 months).
One hundred sixty-nine patients with newly-diagnosed GBM from the control arm of the AVAglio trial (NCT00943826) who presented with early radiographic progressive disease (PD) (< 6 months) were included. Clinical characteristics, topographical patterns, and radiomic features were compared between newly-diagnosed GBM exhibiting early PD and early death (< 12-month ROS, "true PD") with those exhibiting early PD and a long residual survival (> 12-month ROS, "clinically-defined PsP").
"Clinically-defined PsP" occurred to 38.5% of patients with early PD, and was more associated with MGMT methylation (P = 0.02), younger age (P = 0.003), better neurological performance (P = 0.01), and lower contrast-enhancing tumor volume (P = 0.002) at baseline. GBM showing "true PD" occurred more frequently in the right internal capsule, thalamus, lentiform nucleus, and temporal lobe than those with "clinical PsP". Radiomic analysis predicted "clinical PsP" with > 70% accuracy on the validation dataset.
Patients with early PD that eventually exhibit "clinically-defined PsP" have distinct clinical, molecular, and MRI characteristics. This information may be useful for treating clinicians to better understand the potential risks and outcome in patients exhibiting early radiographic changes following chemoradiation.
假性进展（PsP）仍然是一种难以捉摸且在临床上很重要但尚未明确定义的现象，通常涉及早期放射学进展（增强）后的一段时间，随后是放射学稳定或消退。在本研究中，我们利用新诊断胶质母细胞瘤 III 期临床试验对照臂的数据，探索了“临床定义的 PsP”（放射治疗后 6 个月内进展的无进展生存期（PFS）<6 个月）的影像学特征，随后是较长的进展后残留总生存期（ROS>12 个月）。
纳入 AVAglio 试验对照臂中 169 例新诊断为胶质母细胞瘤的患者（NCT00943826），这些患者在放射治疗后早期出现放射性进展性疾病（PD）（<6 个月）。比较新诊断的胶质母细胞瘤中早期 PD 且早期死亡（ROS<12 个月，“真正 PD”）和早期 PD 且残留存活时间较长（ROS>12 个月，“临床定义的 PsP”）患者的临床特征、拓扑模式和放射组学特征。
38.5%的早期 PD 患者出现“临床定义的 PsP”，MGMT 甲基化（P=0.02）、年龄较小（P=0.003）、神经功能较好（P=0.01）和基线时对比增强肿瘤体积较低（P=0.002）与“临床定义的 PsP”相关。显示“真正 PD”的胶质母细胞瘤在右侧内囊、丘脑、豆状核和颞叶的发生率高于那些显示“临床 PsP”的胶质母细胞瘤。放射组学分析在验证数据集上以>70%的准确率预测“临床 PsP”。
早期 PD 最终表现为“临床定义的 PsP”的患者具有独特的临床、分子和 MRI 特征。这些信息可能对治疗临床医生有用，有助于他们更好地了解在接受放化疗后出现早期放射学变化的患者的潜在风险和结果。
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