Kim Minjae, Park Ji Eun, Yoon Shin Kyo, Kim Nakyoung, Kim Young-Hoon, Kim Jeong Hoon, Kim Ho Sung
Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 43 Olympic-ro 88, Songpa-Gu, Seoul, 05505, Korea.
Department of Radiology and Research Institute of Radiological Science and Center for Clinical Imaging Data Science, Yonsei University College of Medicine, Seoul, Korea.
Eur Radiol. 2023 Jun;33(6):4475-4485. doi: 10.1007/s00330-022-09164-w. Epub 2022 Oct 15.
Anti-angiogenic therapy may not benefit all patients with recurrent glioblastomas, and imaging biomarker predicting treatment response to anti-angiogenic therapy is currently limited. We aimed to develop and validate vascular habitats based on perfusion and vessel size to predict time to progression (TTP) in patients with recurrent glioblastomas treated with bevacizumab.
Sixty-nine patients with recurrent glioblastomas treated with bevacizumab who underwent pretreatment MRI with dynamic susceptibility contrast imaging and vessel architectural imaging were enrolled. Vascular habitats were constructed using vessel size index (VSI) and relative cerebral blood volume (rCBV). Associations with vascular habitats and TTP were analyzed using Cox proportional hazard regression analysis. In a prospectively enrolled validation cohort consisting of 15 patients ( ClinicalTrials.gov identifier; NCT04143425), stratification of TTP was demonstrated by the Kaplan-Meier method (log-rank test) using vascular habitats.
Three vascular habitats consisting of high, intermediate, and low angiogenic habitats were identified with rCBV and VSI. Both high angiogenic and intermediate angiogenic habitats were significantly associated with a shorter TTP (hazard ratio [HR], 2.78 and 1.82, respectively; largest p = .003) and so was rCBV (HR, 2.15; p = .02). Concordance probability index of vascular habitat combining high and intermediate angiogenic habitats was 0.74. Vascular habitats stratified patients as good or poor responder in a prospective cohort (p = .059).
Perfusion- and vessel size-derived vascular habitats predicted TTP in recurrent glioblastomas treated with anti-angiogenic therapy and aided patient stratification in a prospective validation cohort.
ClinicalTrials.gov identifier: NCT04143425 KEY POINTS: • High and intermediate angiogenic habitats predicted TTP in recurrent glioblastomas treated with anti-angiogenic therapy. • Vascular habitats combining high and intermediate angiogenic habitats aided patient stratification for anti-angiogenic therapy in recurrent glioblastomas.
抗血管生成疗法可能并非对所有复发性胶质母细胞瘤患者都有益，目前预测抗血管生成疗法治疗反应的影像学生物标志物有限。我们旨在基于灌注和血管大小开发并验证血管微环境，以预测接受贝伐单抗治疗的复发性胶质母细胞瘤患者的疾病进展时间（TTP）。
纳入69例接受贝伐单抗治疗的复发性胶质母细胞瘤患者，这些患者在治疗前接受了磁共振成像（MRI）检查，包括动态磁敏感对比成像和血管结构成像。使用血管大小指数（VSI）和相对脑血容量（rCBV）构建血管微环境。采用Cox比例风险回归分析评估血管微环境与TTP的相关性。在一个由15例患者组成的前瞻性验证队列中（ClinicalTrials.gov标识符：NCT04143425），使用血管微环境通过Kaplan-Meier方法（对数秩检验）对TTP进行分层。
利用rCBV和VSI确定了三种血管微环境，即高血管生成微环境、中血管生成微环境和低血管生成微环境。高血管生成微环境和中血管生成微环境均与较短的TTP显著相关（风险比[HR]分别为2.78和1.82；最大p = 0.003），rCBV也是如此（HR为2.15；p = 0.02）。结合高血管生成微环境和中血管生成微环境的血管微环境一致性概率指数为0.74。在一个前瞻性队列中，血管微环境将患者分为反应良好或反应不佳组（p = 0.059）。
基于灌注和血管大小的血管微环境可预测接受抗血管生成疗法治疗的复发性胶质母细胞瘤患者的TTP，并在前瞻性验证队列中有助于患者分层。
ClinicalTrials.gov标识符：NCT04143425 要点：• 高血管生成微环境和中血管生成微环境可预测接受抗血管生成疗法治疗的复发性胶质母细胞瘤患者的TTP。• 结合高血管生成微环境和中血管生成微环境的血管微环境有助于复发性胶质母细胞瘤患者抗血管生成疗法的分层。
