中期表观扩散系数值在预测接受放射治疗的局部晚期宫颈癌患者的治疗反应中的实用性

IF 2.7 3区医学 Q3 ONCOLOGY Clinical and Translational Radiation Oncology Pub Date : 2024-07-28 DOI:10.1016/j.ctro.2024.100827

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引用次数: 0

摘要

背景对于局部晚期宫颈癌（LACC），即使国际妇产科联盟（FIGO）的分期相同，放疗（RT）的治疗反应也会有很大差异。本研究探讨了 ADC 指标对转诊接受 RT 治疗的 LACC 患者治疗终末结果的预测价值。对所有参与者至少进行了三次腹部或盆腔核磁共振扫描：RT 前、RT 开始后三周以及 RT 结束后约两个月。LACC的表观扩散系数（ADC）计算值包括：ADC前、ADC中期、ΔADC和Δ%ADC。根据实体瘤反应评价标准（RECIST）1.1，计算受试者的ADC值，然后将受试者分为良好反应组（完全反应）和不良反应组（疾病进展、疾病稳定或部分反应）。结果与良好反应组相比，不良反应组受试者的中期ADC、ΔADC和Δ%ADC值明显较低（P均为0.05）。为了区分反应良好者和反应不佳者，利用 ROC 曲线确定中期-ADC、ΔADC 和 Δ%ADC 的最佳临界值分别为 1.067 × 10-3 mm2/秒、0.209 × 10-3 mm2/秒和 30.74 %，相应的敏感性分别为 83.78 %、86.49 % 和 75.68 %，特异性分别为 88.37 %、86.49 % 和 75.68 %。多变量逻辑回归显示，基线肿瘤直径和中期ADC是治疗反应的重要预后因素，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），中期ADC的比值比（OR）为42.896（95 % CI 8.205-224.262）。

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

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 P < 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 × 10⁻³ mm²/sec, 0.209 × 10⁻³ mm²/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.