Heitmann Franziska, Christ Sebastian M, March Christine, Pech Maciej, Thormann Maximilian, Damm Robert
Department of Radiology and Nuclear Medicine, University Hospital Magdeburg, University of Magdeburg, Magdeburg, Germany.
Department of Radiation Oncology, University Hospital Zurich, Zurich, Switzerland.
In Vivo. 2025 Jan-Feb;39(1):292-301. doi: 10.21873/invivo.13827.
BACKGROUND/AIM: To assess the ability of apparent diffusion coefficient (ADC) at baseline in predicting overall survival in patients who undergo Y90-radioembolization (Y90-RE) for liver-dominant metastatic colorectal cancer (mCRC) in the salvage situation.
A retrospective review of 411 lesions in 63 patients with refractory mCRC treated with Y90-RE was conducted. Manual region of interest (ROI) measurements were applied using a whole lesion and volume method. Minimum and mean ADC values were measured, and averages were calculated per patient. Ratios combining tumor volume and ADC were correlated with OS, and a receiver-operating characteristic (ROC) analysis defined a cut-off value. Cox regression analysis was performed, and the log-rank test confirmed prognostic cut-off levels for survival.
The median survival was 6.4 months. Multivariate Cox regression identified tumor volume divided by minimum ADC (ADC) as an independent predictor of OS (HR=1.814, 95%CI=1.188-2.770, p=0.006). Neither ADCmin nor ADCmean were significantly associated with survival. Optimal prediction was identified with a ADC cut-off of 0.3673 arbitrary units (AU) yielding 76.0% sensitivity and 70.3% specificity. Patients with ADC <0.3673 had a median OS of 10.4 months, compared to 4.7 months for those above the cut-off (p<0.001).
Tumor volume divided by minimum ADC at baseline (ADC) was identified as an independent predictor of OS in mCRC scheduled for Y90-radioembolization in the salvage situation and may improve future patient selection.
背景/目的：评估基线表观扩散系数（ADC）预测挽救性肝转移为主的转移性结直肠癌（mCRC）患者接受钇90放射性栓塞（Y90-RE）治疗后总生存期的能力。
对63例接受Y90-RE治疗的难治性mCRC患者的411个病灶进行回顾性研究。采用全病灶和体积法进行手动感兴趣区（ROI）测量。测量最小和平均ADC值，并计算每位患者的平均值。将肿瘤体积与ADC相结合的比值与总生存期进行相关性分析，并通过受试者操作特征（ROC）分析确定临界值。进行Cox回归分析，对数秩检验确定生存的预后临界水平。
中位生存期为6.4个月。多因素Cox回归分析确定肿瘤体积除以最小ADC（ADC）是总生存期的独立预测因素（HR=1.814，95%CI=1.188-2.770，p=0.006）。最小ADC值（ADCmin）和平均ADC值（ADCmean）均与生存期无显著相关性。ADC临界值为0.3673任意单位（AU）时预测效果最佳，灵敏度为76.0%，特异度为70.3%。ADC<0.3673的患者中位总生存期为10.4个月，而高于临界值的患者为4.7个月（p<0.001）。
基线时肿瘤体积除以最小ADC（ADC）被确定为挽救性情况下计划接受Y90放射性栓塞治疗的mCRC患者总生存期的独立预测因素，可能有助于改善未来患者的选择。
