Smits Hilde J G, Vink Saskia J, de Ridder Mischa, Philippens Marielle E P, Dankbaar Jan W
Department of Radiotherapy, University Medical Center Utrecht, Utrecht, The Netherlands.
Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands.
Clin Transl Radiat Oncol. 2024 Sep 12;49:100857. doi: 10.1016/j.ctro.2024.100857. eCollection 2024 Nov.
This study aimed to determine the prognostic value of radiological magnetic resonance imaging (MRI) variables and dynamic contrast enhanced (DCE)-MRI for local control (LC), disease control (DC), and overall survival (OS) in laryngeal and hypopharyngeal cancer patients after radiotherapy.
320 patients treated with radiotherapy were retrospectively included. Pretreatment MRIs were evaluated for the following anatomical tumor characteristics: cartilage invasion, extralaryngeal spread, and involvement of the anterior commissure, pre-epiglottic space, and paralaryngeal space.Pretreatment DCE-MRI was available in 89 patients. The median and 95th percentile of the 60-second area under the contrast-distribution-curve (AUC60 and AUC60) were determined in the tumor volume.
Univariable log-rank test determined that extralaryngeal spread, tumor volume and T-stage were prognostic for worse LC, DC, and OS. A low AUC60 (<31.7 mmol·s/L) and thyroid cartilage invasion were prognostic for worse OS.In multivariable analysis, a Cox proportional hazard model showed that a AUC60 ≥ 31.7 mmol·s/L was prognostic for better OS (HR=0.25, <.001). Tumor volume was prognostic for DC (HR=3.42, <.001) and OS (HR=3.27, <.001). No anatomical MRI variables were significantly prognostic for LC, DC, or OS in multivariable analysis when corrected for confounders.
Low pretreatment AUC60 is prognostic for a worse OS, suggesting that poor tumor perfusion leads to worse survival. Large tumor volume is also prognostic for worse DC and OS. Anatomical MRI parameters are not prognostic for any of the evaluated treatment outcomes when corrected for confounders like age, T-stage, N-stage, and tumor volume.
本研究旨在确定放射磁共振成像（MRI）变量和动态对比增强（DCE）-MRI对喉癌和下咽癌患者放疗后局部控制（LC）、疾病控制（DC）和总生存期（OS）的预后价值。
回顾性纳入320例接受放疗的患者。对治疗前的MRI进行评估，以确定以下解剖学肿瘤特征：软骨侵犯、喉外扩散以及前联合、会厌前间隙和喉旁间隙受累情况。89例患者有治疗前的DCE-MRI资料。在肿瘤体积中确定对比剂分布曲线下60秒面积（AUC60）的中位数和第95百分位数。
单变量对数秩检验确定，喉外扩散、肿瘤体积和T分期对较差的LC、DC和OS具有预后意义。低AUC60（<31.7 mmol·s/L）和甲状腺软骨侵犯对较差的OS具有预后意义。在多变量分析中，Cox比例风险模型显示，AUC60≥31.7 mmol·s/L对较好的OS具有预后意义（HR=0.25，P<.001）。肿瘤体积对DC（HR=3.42，P<.001）和OS（HR=3.27，P<.001）具有预后意义。在多变量分析中，校正混杂因素后，没有解剖学MRI变量对LC、DC或OS具有显著的预后意义。
治疗前低AUC60提示较差的OS，表明肿瘤灌注不良导致较差的生存率。大肿瘤体积对较差的DC和OS也具有预后意义。在校正年龄、T分期、N分期和肿瘤体积等混杂因素后，解剖学MRI参数对任何评估的治疗结局均无预后意义。
