Can MRI-derived factors predict the survival in glioblastoma patients treated with postoperative chemoradiation therapy?
Can MRI-derived factors predict the survival in glioblastoma patients treated with postoperative chemoradiation therapy?
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DOI：
10.1258/ar.2012.120525
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发表时间：
2013-03-01
期刊：
影响因子：
1.3
通讯作者：
Yamashita, Yasuyuki
中科院分区：
文献类型：
--
作者：
Nakamura, Hideo;Murakami, Ryuji;Yamashita, Yasuyuki
背景资料：先进的诊断和治疗的发展可能会产生新的预后因素与多形性胶质母细胞瘤（GBM）的患者。目的：为了验证预处理定量扩散加权（DW）磁共振成像（MRI）和MRI的预测价值与GBM患者手术后72小时内进行。材料和方法：在2000年1月至2009年9月期间，138例GBM患者在术前、术后早期和术后1个月时接受了术后放化疗（化疗-RT）和纵向MRI。通过对总生存期（OS）进行因素分析，评估患者年龄、Karnofsky评分（KPS）、治疗前DW-MRI上的最小表观扩散系数（ADC）和术后早期MRI上的大体残留肿瘤的作用。采用Kaplan-Meier法计算生存曲线;采用多变量考克斯比例风险模型校正预后因素的影响。结果：KPS评分（HR为1.812）、最小ADC值（HR为2.365）和大体残留肿瘤（HR为1.777）是独立的预后因素。根据MRI衍生因素，我们将患者分配到RTOG-RPA分类中的不同预后组，并根据风险水平对其进行分组，即最小ADC较低（= 0.93 x 10（-3）mm（2）/s）且无明显残留肿瘤的高风险组;其他患者被分配到中风险组。低、中、高危组的中位OS分别为28.2、14.7和10.8个月（P <0.001）。结论：术前DW-MRI上的最小ADC值和术后早期MRI上的大体残留肿瘤可以预测GBM患者术后化疗-RT的生存率。
Background: Advanced diagnostic and therapeutic developments may yield novel prognostic factors in patients with glioblastoma multiforme (GBM).Purpose: To validate the predictive values of pretreatment quantitative diffusion-weighted (DW) magnetic resonance imaging (MRI) and MRI performed within 72 h after surgery in patients with GBM.Material and Methods: Between January 2000 and September 2009, 138 patients with GBM underwent postoperative chemoradiation therapy (chemo-RT) and longitudinal MRI before surgery, in the early postoperative period, and at 1-month intervals thereafter. The role of the patient age, Karnofsky performance scale (KPS) score, minimum apparent diffusion coefficient (ADC) on pretreatment DW-MRI, and gross residual tumor on early postoperative MRI were assessed by factor analysis of overall survival (OS). Survival curves were calculated using the Kaplan-Meier method; the multivariate Cox's proportional hazards model was used to adjust for the influence of prognostic factors. Radiation Therapy Oncology Group-recursive partitioning analysis (RTOG-RPA) criteria were used to validate the predictive value of the MRI-derived factors.Results: Substantial independent prognostic factors were the KPS score (hazard ratio [HR], 1.812), minimum ADC (HR, 2.365), and gross residual tumor (HR, 1.777). Based on MRI-derived factors, we assigned the patients to different prognostic groups in the RTOG-RPA classification and grouped them according to the level of risk, i.e. a high-risk group with low minimum ADCs (= 0.93 x 10(-3) mm(2)/s) without gross residual tumor; the other patients were assigned to the intermediate-risk group. Median OS for the low-, intermediate-, and high-risk groups were 28.2, 14.7, and 10.8 months, respectively (P < 0.001).Conclusion: The minimum ADC on pretreatment DW-MRI and gross residual tumor on early postoperative MRI can predict the survival in GBM patients treated with postoperative chemo-RT.