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Prognostic value of ADC quantification for clinical outcome in uterine cervical cancer treated with concurrent chemoradiotherapy

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Abstract

Objectives

To investigate the prognostic value of diffusion-weighted imaging (DWI) in predicting clinical outcome in patients with cervical cancer after concurrent chemoradiotherapy (CCRT).

Methods

We enrolled 124 cervical cancer patients who received definitive CCRT and underwent 3 T-MRI before and 1 month after initiating treatment. The mean apparent diffusion coefficient (ADC) value was measured on the tumor and the changes in ADC percentage (ΔADCmean) between the two time points were calculated. The Cox proportion hazard model was used to evaluate the associations between imaging or clinical variables and progression-free survival (PFS), cancer-specific survival (CSS), and overall survival (OS).

Results

In multivariate analysis, ΔADCmean was the only independent predictor of PFS (hazard ratio [HR] = 0.2379, p = 0.005), CSS (HR = 0.310, p = 0.024), and OS (HR = 0.217, p = 0.002). Squamous cell carcinoma antigen, histology, and pretreatment tumor size were significantly independent predictors of PFS. Tumor size response was significantly independent predictor of CSS and OS. Using the cutoff values of ΔADCmean, the PFS was significantly lower for ΔADCmean < 27.8% (p = 0.001). The CSS and OS were significantly lower for ΔADCmean < 16.1% (p = 0.002 and p < 0.001, respectively).

Conclusion

The percentage change in tumor ADC may be a useful predictor of disease progression and survival in patients with cervical cancer treated with CCRT.

Key Points

• DWI is widely used as a potential marker of tumor viability.

• Percentage change in tumor ADC (ΔADC mean ) was an independent marker of PFS, CSS, and OS.

• Survival was better in patients with ≥ ΔADC mean cutoff value than with < the cutoff value.

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Abbreviations

ADC:

Apparent diffusion coefficient

CCRT:

Concurrent chemoradiotherapy

CI:

Confidence interval

CSS:

Cancer-specific survival

DWI:

Diffusion-weighted imaging

EBRT:

External-beam radiotherapy

FIGO:

International Federation of Gynecology and Obstetrics

HR:

Hazard ratio

ICC:

Intraclass correlation coefficient

ICR:

Intracavitary brachytherapy

LN:

Lymph node

MRI:

Magnetic resonance imaging

OS:

Overall survival

PFS:

Progression-free survival

ROI:

Region of interest

SCC:

Squamous cell carcinoma

T2WI:

T2-weighted imaging

THRIVE:

T1-weighted high-resolution isotropic volume examination

ΔADCmean :

Percentage change of mean ADC between two time points

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Acknowledgements

We thank Hye Seung Kim, MS, and Insuk Sohn, PhD, of the Statistics and Data Center, Samsung Medical Center, for statistical assistance.

Funding

This study was supported by the Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education (NRF-2017R1A2B4006020).

Author information

Authors and Affiliations

  1. Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea

    Kyo-won Gu, Chan Kyo Kim & Young Cheol Yoon

  2. Department of Medical Device Management and Research, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea

    Chan Kyo Kim

  3. Department of Digital Health, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea

    Chan Kyo Kim

  4. Departments of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea

    Chel Hun Choi

  5. Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea

    Won Park

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  1. Kyo-won Gu
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Corresponding author

Correspondence to Chan Kyo Kim.

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Guarantor

The scientific guarantor of this publication is Chan Kyo Kim.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

Hye Seung Kim, MD and Insuk Sohn, PhD kindly provided statistical advice for this manuscript.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.

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• retrospective

• diagnostic or prognostic study

• performed at one institution

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Gu, Kw., Kim, C.K., Choi, C.H. et al. Prognostic value of ADC quantification for clinical outcome in uterine cervical cancer treated with concurrent chemoradiotherapy. Eur Radiol 29, 6236–6244 (2019). https://doi.org/10.1007/s00330-019-06204-w

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  • DOI: https://doi.org/10.1007/s00330-019-06204-w

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