MRI assessment of surrounding tissues in soft-tissue sarcoma during neoadjuvant chemotherapy can help predicting response and prognosis
MRI assessment of surrounding tissues in soft-tissue sarcoma during neoadjuvant chemotherapy can help predicting response and prognosis
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DOI：
10.1016/j.ejrad.2018.11.004
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发表时间：
2018-12-01
影响因子：
3.3
通讯作者：
Kind, Michele
中科院分区：
文献类型：
--
作者：
Crombe, Amandine;Le Loarer, Francois;Kind, Michele
目的：探讨MRI评估的软组织肉瘤（STS）在新辅助化疗（NAC）期间周围组织的变化是否与手术标本上的组织学反应和假囊外的卫星肿瘤细胞、无病生存期（DFS）和总生存期（OS）有关。方法：采用单中心回顾性研究方法，对57例局部晚期四肢及干壁高级别STS患者进行研究。所有患者均接受5-6个周期的蒽环类药物NAC、治疗性手术和辅助放疗治疗，并在基线和2个周期后进行可用的磁共振成像。37名患者还进行了术前MRI检查。两名资深放射科医生评估了NAC期间的MRI生长模式、水肿、对比增强水肿、腱膜增强及其质变。一位病理学专家检查了所有的手术标本。良好的组织学反应定义为活细胞< 10%。采用Fisher检验和卡方检验以及二元logistic回归的多变量分析来估计与病理结果的相关性。生存分析包括对数秩检验。结果：42例反应不良，25例手术标本上有卫星肿瘤细胞。周围水肿和对比增强水肿的变化与反应相关（p分别= 0.008和0.011）。基线MRI上的弥漫性浸润性生长模式（IGP）、边缘定义的改变和早期评估时对比增强的水肿与卫星肿瘤细胞相关（p分别= 0.039、0.011和0.009）。基线MRI上弥漫性IGP和治疗期间水肿稳定或加重是DFS的预测因子（p分别= 0.009和0.040）。结论：NAC术中应仔细评估STS周围组织，以指导治疗效果和患者预后。
Objectives: To determine if changes in surrounding tissues of soft-tissue sarcomas (STS) evaluated by MRI during neoadjuvant chemotherapy (NAC) are associated with the histological response and satellite tumorous cells beyond the pseudocapsule on surgical specimen, disease-free survival (DFS) and overall survival (OS).Methods: Fifty-seven adult patients with locally advanced high-grade STS of extremities and trunk wall were included in this single-centre retrospective study. All were uniformly treated by 5-6 cycles of anthracycline-based NAC, curative surgery and adjuvant radiotherapy and had available MRI with a gadolinium-chelates administration at baseline and after 2 cycles. Thirty-seven patients also had a pre-operative MRI. Two senior radiologists evaluated MRI growth pattern, oedema, contrast-enhanced oedema, aponeurotic enhancement, and their qualitative changes during NAC. An expert pathologist reviewed all surgical specimens. A good histological response was defined as < 10% viable cells. Associations with pathological findings were estimated with Fisher and Chi-square tests and multivariate analysis with binary logistic regression. Survival analyses included log-rank tests.Results: Forty-two patients had poor responses and 25 had satellite tumorous cells on surgical specimen. Changes in surrounding oedema and in contrast-enhanced oedema were associated with responses (p = 0.008 and 0.011, respectively). Diffuse infiltrative growth pattern (IGP) on baseline MRI, changes in margin definition and in contrast-enhanced oedema at early evaluation were associated with satellite tumorous cells (p = 0.039, 0.011 and 0.009, respectively). Diffuse IGP on baseline MRI and stable or increased oedema during treatment were predictors of DFS (p = 0.009 and 0.040, respectively).Conclusion: Surrounding tissues of STS during NAC should be carefully evaluated as they may steer treatment efficacy and patient prognosis.