Zhang Yulin, Li Guomin, Chen Jinyan, Jiang Meien, Gao Yunyu, Li Kunsong, Wen Hua, Yan Jianhao
Department of Medical Imaging, the Affiliated Guangdong Second Provincial General Hospital of Jinan University, Guangzhou, China.
The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.
Quant Imaging Med Surg. 2024 Oct 1;14(10):7330-7340. doi: 10.21037/qims-24-188. Epub 2024 Sep 26.
Early detection of nasopharyngeal carcinoma (NPC) patients who are not sensitive to neoadjuvant chemotherapy (NAC) can guard against overtreatment. This study aimed to evaluate the effectiveness of amide proton transfer (APT) imaging and diffusion-weighted imaging (DWI) in predicting the early response to NAC in patients with NPC.
This prospective study enrolled fifty patients with biopsy-confirmed NPC from September 2021 to May 2023. Magnetic resonance imaging (MRI) including APT and DWI, was performed before NAC. After NAC, patients were divided into complete response (CR), partial response (PR), and stable disease (SD) and progressive disease (PD) groups based on the Response Evaluation Criteria in Solid Tumours Version 1.1. The Kruskal-Wallis H test was used for statistical analysis. The differences in APT and apparent diffusion coefficient (ADC) values among the different efficacy groups were compared, the receiver operating characteristic (ROC) curve was drawn for statistically significant parameters, and the area under the curve (AUC) was calculated.
Fifty patients (mean age: 47±14 years; 42 males and 8 females) were included in the final analysis (11 were in the CR group, 30 in the PR group, 9 in the SD group, and 0 in the PD group). The ADC values showed no significant differences among the different treatment response groups. The SD group showed significantly lower APT (P=0.025), APT (P=0.025) and APT (P=0.001) values than the CR and PR groups. Setting APT =3.10% as the cut-off value, optimal diagnostic performance (AUC: 0.831; sensitivity: 0.778; specificity: 0.878) was obtained in predicting the SD group.
APT imaging can predict the early tumour response to NAC in patients with NPC. APT imaging may be superior to DWI in predicting tumour response.
早期发现对新辅助化疗（NAC）不敏感的鼻咽癌（NPC）患者可避免过度治疗。本研究旨在评估酰胺质子转移（APT）成像和扩散加权成像（DWI）在预测NPC患者对NAC早期反应中的有效性。
本前瞻性研究纳入了2021年9月至2023年5月间50例经活检确诊的NPC患者。在NAC前进行包括APT和DWI在内的磁共振成像（MRI）检查。NAC后，根据实体瘤疗效评价标准第1.1版将患者分为完全缓解（CR）、部分缓解（PR）、疾病稳定（SD）和疾病进展（PD）组。采用Kruskal-Wallis H检验进行统计分析。比较不同疗效组间APT和表观扩散系数（ADC）值的差异，对有统计学意义的参数绘制受试者操作特征（ROC）曲线，并计算曲线下面积（AUC）。
最终纳入50例患者（平均年龄：47±14岁；男性42例，女性8例）进行分析（CR组11例，PR组30例，SD组9例，PD组0例）。不同治疗反应组间ADC值无显著差异。SD组的APT值（P=0.025）、APT值（P=0.025）和APT值（P=0.001）显著低于CR组和PR组。将APT=3.10%作为临界值，在预测SD组时获得了最佳诊断性能（AUC：0.831；灵敏度：0.778；特异度：0.878）。
APT成像可预测NPC患者肿瘤对NAC的早期反应。在预测肿瘤反应方面，APT成像可能优于DWI。
