Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
J Neurooncol. 2023 May;163(1):173-183. doi: 10.1007/s11060-023-04324-4. Epub 2023 May 2.
Autologous tumor lysate-loaded dendritic cell vaccine (DCVax-L) is a promising treatment modality for glioblastomas. The purpose of this study was to investigate the potential utility of multiparametric MRI-based prediction model in evaluating treatment response in glioblastoma patients treated with DCVax-L.
Seventeen glioblastoma patients treated with standard-of-care therapy + DCVax-L were included. When tumor progression (TP) was suspected and repeat surgery was being contemplated, we sought to ascertain the number of cases correctly classified as TP + mixed response or pseudoprogression (PsP) from multiparametric MRI-based prediction model using histopathology/mRANO criteria as ground truth. Multiparametric MRI model consisted of predictive probabilities (PP) of tumor progression computed from diffusion and perfusion MRI-derived parameters. A comparison of overall survival (OS) was performed between patients treated with standard-of-care therapy + DCVax-L and standard-of-care therapy alone (external controls). Additionally, Kaplan-Meier analyses were performed to compare OS between two groups of patients using PsP, Ki-67, and MGMT promoter methylation status as stratification variables.
Multiparametric MRI model correctly predicted TP + mixed response in 72.7% of cases (8/11) and PsP in 83.3% (5/6) with an overall concordance rate of 76.5% with final diagnosis as determined by histopathology/mRANO criteria. There was a significant concordant correlation coefficient between PP values and histopathology/mRANO criteria (r = 0.54; p = 0.026). DCVax-L-treated patients had significantly prolonged OS than those treated with standard-of-care therapy (22.38 ± 12.8 vs. 13.8 ± 9.5 months, p = 0.040). Additionally, glioblastomas with PsP, MGMT promoter methylation status, and Ki-67 values below median had longer OS than their counterparts.
Multiparametric MRI-based prediction model can assess treatment response to DCVax-L in patients with glioblastoma.
自体肿瘤裂解物负载树突状细胞疫苗（DCVax-L）是治疗胶质母细胞瘤的一种很有前途的治疗方法。本研究的目的是探讨基于多参数 MRI 的预测模型在评估接受 DCVax-L 治疗的胶质母细胞瘤患者治疗反应中的潜在应用价值。
纳入 17 例接受标准治疗加 DCVax-L 治疗的胶质母细胞瘤患者。当怀疑肿瘤进展（TP）且考虑重复手术时，我们试图根据组织病理学/mRANO 标准确定基于多参数 MRI 的预测模型在区分 TP+混合反应或假性进展（PsP）方面的准确性，将其作为ground truth。多参数 MRI 模型由扩散和灌注 MRI 衍生参数计算得出的肿瘤进展预测概率（PP）组成。比较接受标准治疗加 DCVax-L 治疗与单独接受标准治疗的患者的总生存期（OS）。此外，还进行 Kaplan-Meier 分析，比较使用 PsP、Ki-67 和 MGMT 启动子甲基化状态作为分层变量的两组患者的 OS。
多参数 MRI 模型正确预测 TP+混合反应的病例占 72.7%（8/11），预测 PsP 的病例占 83.3%（5/6），总体一致性率为 76.5%，与组织病理学/mRANO 标准确定的最终诊断一致。PP 值与组织病理学/mRANO 标准之间存在显著的一致性相关系数（r=0.54；p=0.026）。接受 DCVax-L 治疗的患者的 OS 明显长于接受标准治疗的患者（22.38±12.8 与 13.8±9.5 个月，p=0.040）。此外，PsP、MGMT 启动子甲基化状态和 Ki-67 值低于中位数的胶质母细胞瘤患者的 OS 更长。
基于多参数 MRI 的预测模型可评估胶质母细胞瘤患者对 DCVax-L 的治疗反应。
