局部晚期宫颈癌患者放疗期间表观扩散系数值中期预测治疗反应的效用

Utility of interim apparent diffusion coefficient value in predicting treatment response among patients with locally advanced cervical cancer treated with radiotherapy.

作者信息

Liang Chunyu, Wang Wei, Yang Guohui, Xu Zhiyuan, Li Jian, Wu Kusheng, Shen Xinping

机构信息

Department of Medical Imaging, Radiology Center, The University of Hong Kong-Shenzhen Hospital, 518000 Shenzhen, Guangdong, China.

Department of Clinical Oncology, The University of Hong Kong-Shenzhen Hospital, 518000 Shenzhen, Guangdong, China.

出版信息

Clin Transl Radiat Oncol. 2024 Jul 28;48:100827. doi: 10.1016/j.ctro.2024.100827. eCollection 2024 Sep.

DOI:10.1016/j.ctro.2024.100827

PMID:39192879

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11347826/

Abstract

BACKGROUND

For locally advanced cervical cancer (LACC), treatment response to radiotherapy (RT) can vary significantly even among those with the same stage classification of International Federation of Gynecology and Obstetrics (FIGO). This study investigated the value of ADC metric for forecasting end-of-treatment outcomes in LACC patients referred for RT.

METHODS

Eighty patients with pathologically confirmed cervical squamous cell carcinoma with (SCC) were included in the research. Abdominal or pelvic MRI scans were conducted at least three times for all participants: before RT, three weeks after beginning of RT and approximately two months after RT was finalized. Calculated apparent diffusion coefficient (ADC) values of the LACC include: pre-ADC, interim-ADC, ΔADC and Δ%ADC. Based on Response Evaluation Criteria in Solid Tumors (RECIST) 1.1, subjects were calculated and subsequently categorized into good responders group (complete response) and poor responders group (progressive disease, stable disease or partial response).

RESULTS

Compared to good-responders, subjects of poor-responder group showed significantly lower values of interim-ADC, ΔADC, and Δ%ADC (all < 0.05). To distinguish between good and poor responders, the optimal cutoff values of interim-ADC, ΔADC, and Δ%ADC were determined to be 1.067 × 10 mm/sec, 0.209 × 10 mm/sec, and 30.74 % using the ROC curve, with corresponding sensitivities of 83.78 %, 86.49 %, 75.68 %, and specificities of 88.37 %, 86.49 %, 75.68 %, respectively. Multivariate logistic regression revealed that the baseline tumor diameter and interim-ADC were significant prognostic factors for treatment response with an odds ratio (OR) of 0.105 (95 % confidence interval [95 % CI] 0.018-0.616) for baseline tumor diameter and 42.896 (95 % CI 8.205-224.262) for interim-ADC.

CONCLUSION

The interim-ADC value and baseline tumor diameter surfaced as possible indicative factors for predicting the response to RT in patients with LACC.

摘要

背景

对于局部晚期宫颈癌（LACC），即使在国际妇产科联盟（FIGO）分期相同的患者中，放疗（RT）的治疗反应也可能有显著差异。本研究探讨了表观扩散系数（ADC）指标对接受放疗的LACC患者治疗结局的预测价值。

方法

80例经病理确诊为宫颈鳞状细胞癌（SCC）的患者纳入研究。所有参与者至少进行三次腹部或盆腔MRI扫描：放疗前、放疗开始后三周以及放疗结束后约两个月。计算得出的LACC的表观扩散系数（ADC）值包括：放疗前ADC、放疗中期ADC、ΔADC和Δ%ADC。根据实体瘤疗效评价标准（RECIST）1.1，对受试者进行计算并随后分为良好反应者组（完全缓解）和不良反应者组（疾病进展、疾病稳定或部分缓解）。

结果

与良好反应者相比，不良反应者组的受试者放疗中期ADC、ΔADC和Δ%ADC值显著更低（均P<0.05）。为区分良好和不良反应者，使用ROC曲线确定放疗中期ADC、ΔADC和Δ%ADC的最佳截断值分别为1.067×10⁻³mm²/sec、0.209×10⁻³mm²/sec和30.74%，相应的敏感度分别为83.78%、86.49%、75.68%，特异度分别为88.37%、86.49%、75.68%。多因素逻辑回归显示，基线肿瘤直径和放疗中期ADC是治疗反应的显著预后因素，基线肿瘤直径的比值比（OR）为0.105（95%置信区间[95%CI]0.018 - 0.616），放疗中期ADC的OR为42.896（95%CI 8.205 - 224.262）。