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Pre-treatment amide proton transfer imaging predicts treatment outcome in nasopharyngeal carcinoma

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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).

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Ann D. King.

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Guarantor

The scientific guarantor of this study is Ann D. King.

Conflict of interest

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

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