Department of Radiology, Medical College of Wisconsin, 8701 Watertown Plank Rd, 53226, Milwaukee, WI, USA.
Department of Biophysics, Medical College of Wisconsin, Milwaukee, WI, USA.
J Neurooncol. 2024 Apr;167(2):233-241. doi: 10.1007/s11060-024-04593-7. Epub 2024 Feb 19.
Autopsy-based radio-pathomic maps of glioma pathology have shown substantial promise inidentifying areas of non-enhancing tumor presence, which may be able to differentiate subsets of patients that respond favorably to treatments such as bevacizumab that have shown mixed efficacy evidence. We tested the hypthesis that phenotypes of non-enhancing tumor fronts can distinguish between glioblastoma patients that will respond favorably to bevacizumab and will visually capture treatment response.
T1, T1C, FLAIR, and ADC images were used to generate radio-pathomic maps of tumor characteristics for 79 pre-treatment patients with a primary GBM or high-grade IDH1-mutant astrocytoma for this study. Novel phenotyping (hypercellular, hypocellular, hybrid, or well-circumscribed front) of the non-enhancing tumor front was performed on each case. Kaplan Meier analyses were then used to assess differences in survival and bevacizumab efficacy between phenotypes. Phenotype compartment segmentations generated longitudinally for a subset of 26 patients over the course of bevacizumab treatment, where a mixed effect model was used to detect longitudinal changes.
Well-Circumscribed patients showed significant/trending increases in survival compared to Hypercellular Front (HR = 2.0, p = 0.05), Hypocellular Front (HR = 2.02, p = 0.03), and Hybrid Front tumors (HR = 1.75, p = 0.09). Only patients with hypocellular or hybrid fronts showed significant survival benefits from bevacizumab treatment (HR = 2.35, p = 0.02; and HR = 2.45, p = 0.03, respectively). Hypocellular volumes decreased by an average 50.52 mm per day of bevacizumab treatment (p = 0.002).
Patients with a hypocellular tumor front identified by radio-pathomic maps showed improved treatment efficacy when treated with bevacizumab, and reducing hypocellular volumes over the course of treatment may indicate treatment response.
基于尸检的胶质瘤病理放射组学图谱在识别非增强肿瘤存在区域方面显示出很大的潜力，这些区域可能能够区分对贝伐单抗等治疗反应良好的患者亚组，这些治疗的疗效证据存在混合。我们检验了这样一个假设，即非增强肿瘤前缘的表型可以区分对贝伐单抗反应良好并能在视觉上捕捉治疗反应的胶质母细胞瘤患者。
本研究使用 79 名初诊为胶质母细胞瘤或高级别 IDH1 突变型星形细胞瘤患者的 T1、T1C、FLAIR 和 ADC 图像，生成肿瘤特征的放射组学图谱。对每个病例的非增强肿瘤前缘进行了新的表型（高细胞、低细胞、混合或边界清楚的前缘）分析。然后使用 Kaplan-Meier 分析评估不同表型之间的生存和贝伐单抗疗效差异。对 26 例患者中的一部分患者进行了纵向表型区隔分割，在贝伐单抗治疗过程中使用混合效应模型来检测纵向变化。
边界清楚的患者与高细胞前缘（HR=2.0，p=0.05）、低细胞前缘（HR=2.02，p=0.03）和混合前缘肿瘤（HR=1.75，p=0.09）相比，生存显著/呈上升趋势。只有低细胞或混合前缘的患者从贝伐单抗治疗中获得了显著的生存益处（HR=2.35，p=0.02；和 HR=2.45，p=0.03）。低细胞体积在贝伐单抗治疗的每一天平均减少 50.52mm³（p=0.002）。
通过放射组学图谱识别的低细胞肿瘤前缘患者在接受贝伐单抗治疗时显示出更好的治疗效果，并且在治疗过程中减少低细胞体积可能表明治疗反应。
