Abstract
Objective
To investigate the value of pre-treatment amide proton transfer–weighted (APTw) imaging for predicting survival of patients with nasopharyngeal carcinoma (NPC).
Materials and methods
Pre-treatment APTw imaging was performed in 77 NPC patients and the mean, 90th percentile, skewness, and kurtosis of APT asymmetry (APTmean, APT90, APTskewness, and APTkurtosis, respectively) were obtained from the primary tumor. Associations of APTw parameters with locoregional relapse–free survival (LRRFS), distant metastasis–free survival (DMFS), and disease-free survival (DFS) after 2 years were assessed by univariable Cox regression analysis and significant APTw parameters, together with age, sex, treatment, and stage as confounding variables, were added to the multivariable model. Kaplan-Meier analysis was used to determine the prognostic significance of patients with high or low APT values based on a threshold value from receiver operating characteristic curve analysis.
Results
Locoregional relapse, distant metastases, and disease relapse occurred in 14/77 (18%), 10/77 (13%), and 20/77 (26%) patients, respectively, at a median follow-up of 48.3 (10.6–67.4) months. Univariable analysis showed significant associations of LRRFS with APTskewness (HR = 1.98; p = 0.034), DMFS with APTmean (HR = 2.44; p = 0.033), and APT90 (HR = 1.93; p = 0.009), and DFS with APTmean (HR = 2.01; p = 0.016), APT90 (HR = 1.68; p = 0.009), and APTskewness (HR = 1.85; p = 0.029). In multivariable analysis, the significant predictors for DMFS were APT90 (HR = 3.51; p = 0.004) and nodal stage (HR = 5.95; p = 0.034) and for DFS were APT90 (HR = 1.97; p = 0.010) and age (HR = 0.92; p = 0.014). An APT90 ≥ 4.38% was associated with a significantly poorer DFS at 2 years than APT90 < 4.38% (66% vs. 91%; HR = 4.01; p = 0.005).
Conclusion
APTw imaging may potentially predict survival in patients with NPC.
Key Points
• APTw imaging may provide new markers to predict survival in nasopharyngeal carcinoma.
• APT90 is an independent predictor of distant metastases–free survival and disease-free survival.
• The APThigh group is at higher risk of disease relapse than the APTlow group.
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Abbreviations
- APT:
-
Amide proton transfer
- APT90 :
-
90th percentile of APT asymmetry
- APTkurtosis :
-
Kurtosis of APT asymmetry
- APTmean :
-
Mean value of APT asymmetry
- APTskewness :
-
Skewness of APT asymmetry
- DFS:
-
Disease-free survival
- DMFS:
-
Distant metastases–free survival
- LRRFS:
-
Locoregional relapse–free survival
- NPC:
-
Nasopharyngeal carcinoma
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Acknowledgments
The authors thank Dr Jinyuan Zhou, Department of Radiology, Johns Hopkins University, for providing technical advice on pulse sequencing.
Funding
The work described in this paper was supported by grants from the Research Grants council of the Hong Kong Special Administrative Region, China (Project No. CUHK141070/14 and SEG_CUHK02).
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The scientific guarantor of this study is Ann D. King.
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The authors of this manuscript declare no financial or other conflicts of interest with the publication of this work.
Statistics and biometry
One of the authors has significant statistical expertise.
Informed consent
Written informed consent was obtained from all patients in this study.
Ethical approval
Approval was obtained by the local institutional ethics committee.
Study subjects or cohorts overlap
Of the 77 NPC patients included in the study, 53 were included in a previously reported tumor characterization study [19] and 12 in an early intra-treatment study of short-term outcome prediction [29], which differs from the current study which analyses the pre-treatment APTw imaging to predict outcome.
Methodology
• Retrospective
• Diagnostic or prognostic study
• Performed at one institution
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Qamar, S., King, A.D., Ai, QY.H. et al. Pre-treatment amide proton transfer imaging predicts treatment outcome in nasopharyngeal carcinoma. Eur Radiol 30, 6339–6347 (2020). https://doi.org/10.1007/s00330-020-06985-5
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DOI: https://doi.org/10.1007/s00330-020-06985-5