Additional value of dynamic iodine concentration derived from dual-energy CT in larynx preservation decision following neoadjuvant chemotherapy

IF 2.1 3区医学 Q2 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Clinical radiology Pub Date : 2025-01-01 DOI:10.1016/j.crad.2024.106749

P. Ma , W. Li , X. Bao , H. Wang , W. Li , Y. Li

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Abstract

Aim

To develop a larynx preservation (LP) score model to predict laryngectomy-free survival (LFS) in advanced laryngeal squamous-cell carcinoma (LSCC) with morphological response to neoadjuvant chemotherapy (NAC).

Materials and Methods

In this retrospective study, patients with advanced LSCC were included. All patients were classified into NAC response and non-response groups according RECIST. Arterial and venous phases of standardized iodine concentrations of dual-energy CT were measured in the response group, and the rate of iodine concentration change (ΔNIC%) was calculated by (NICpost-NICpre)/NICpre ×100%. Clinical outcomes between the two groups were analyzed using chi-square test. Univariable and multivariable cox regression analyses were performed to evaluate the independent predictors of LFS in the response group. A risk score was developed based on the hazard ratios from the multivariable analysis.

Results

A total of 146 patients were included. 86 patients achieved a response. T stage, N status, and ΔNAIC% were independent predictors of LFS for LSCC patients with NAC morphological response (all, p<0.001). Based on these factors, the established LP risk score model demonstrated an AUC of 0.877 for the 1-year LFS rate and 0.950 for the 2-year LFS rate. Patients with a score ≥6 had a worse LFS (p<0.001) and OS (p=0.001).

Conclusion

A prediction risk score incorporating T stage, N status, and ΔNAIC% shows good predictive effectiveness for LFS in advanced LSCC with morphological response to NAC. It can prevent high-risk patients in the NAC response group from undergoing salvage laryngectomy and improve patient prognosis.

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双能CT动态碘浓度在新辅助化疗后喉保留决策中的附加价值。

目的：建立喉部保存（LP）评分模型，预测对新辅助化疗（NAC）有形态学反应的晚期喉部鳞状细胞癌（LSCC）的无喉切除术生存率（LFS）。材料和方法：本回顾性研究纳入晚期LSCC患者。根据RECIST将所有患者分为NAC反应组和无反应组。测量缓解组双能CT标准碘浓度的动脉期和静脉期，通过(NICpost-NICpre)/NICpre ×100%计算碘浓度变化率（ΔNIC%）。采用卡方检验对两组临床结果进行分析。采用单变量和多变量cox回归分析评估反应组LFS的独立预测因素。根据多变量分析的风险比建立风险评分。结果：共纳入146例患者。86名患者获得了应答。T分期、N状态和ΔNAIC%是具有NAC形态反应的LSCC患者LFS的独立预测因子（均，p）。结论：结合T分期、N状态和ΔNAIC%的预测风险评分对具有NAC形态反应的晚期LSCC的LFS具有良好的预测效果。可预防NAC反应组高危患者行补救性喉切除术，改善患者预后。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical radiology 医学-核医学

CiteScore

4.70

自引率

3.80%

发文量

528

审稿时长

76 days

期刊介绍： Clinical Radiology is published by Elsevier on behalf of The Royal College of Radiologists. Clinical Radiology is an International Journal bringing you original research, editorials and review articles on all aspects of diagnostic imaging, including: • Computed tomography • Magnetic resonance imaging • Ultrasonography • Digital radiology • Interventional radiology • Radiography • Nuclear medicine Papers on radiological protection, quality assurance, audit in radiology and matters relating to radiological training and education are also included. In addition, each issue contains correspondence, book reviews and notices of forthcoming events.