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Systemic treatment of the metastatic renal cell carcinoma: usefulness of the apparent diffusion coefficient of diffusion-weighted MRI in prediction of early therapeutic response

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Abstract

Accurate prediction of early treatment response to systemic therapy (ST) with tyrosine kinase inhibitors (TKI) in patients with metastatic renal cell carcinoma (mRCC) could help avoid ineffective and expensive treatment with serious side effects. Neither RECIST v.1.1 nor Choi criteria successfully discriminate between patients with mRCC who received ST having a short or long time to progression (TTP). There is no biomarker, which is able to predict early therapeutic response to TKIs application in patients with mRCC. The goal of our study was to investigate the potential of apparent diffusion coefficient (ADC) of diffusion-weighted imaging (DWI) of MRI in prediction of early therapeutic response to ST with pazopanib in patients with mRCC. The retrospective study enrolled 32 adult patients with conventional mRCC who received pazopanib (mean duration—7.5 ± 3.45). The mean duration of follow-up was 11.85 ± 4.34 months. In all patients as baseline examination and 1 month after treatment, 1.5T MRI including DWI sequence was performed followed by ADC measurement of the main renal lesion. For assessment of the therapeutic response, RECIST 1.1 is used. Partial response (PR), stable disease (SD) and progressive disease (PD) were observed in 12 (37.50%), 10 (31.25%) and 10 (31.25%) cases with mean TTP of 10.33 ± 2.06 months (95% confidence interval, CI = 9.05–11.61), 7.40 ± 2.50 months (95% CI = 5.61–9.19) and 4.20 ± 1.99 months (95% CI = 2.78–5.62) accordingly (p < 0.05). There was no difference in change of main lesions’ longest size 1 month after ST in patients with PR, SD and PD. Comparison of mean ADC values before and 1 month after systemic treatment showed significant decrease by 19.11 ± 10.64% (95% CI = 12.35–25.87) and by 7.66 ± 6.72% (95% CI = 2.86–12.47) in subgroups with PR and SD, respectively (p < 0.05). There was shorter TTP in patients with mRCC if ADC of the main renal lesion 1 month after the ST increased from the baseline less than 1.73% compared to patients with ADC levels above this threshold: 5.29 ± 3.45 versus 9.50 ± 2.04 months accordingly (p < 0.001). Overall, our findings highlighted the use of ADC as a predictive biomarker for early therapeutic response assessment. Use of ADC will be effective and useful for reliable prediction of responders and non-responders to systemic treatment with pazopanib.

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Funding

This study was supported by the Scientific Grant Agency of the Ministry of Education of the Slovak Republic under the Contract No. Grant VEGA 1/0873/18.

Author information

Authors and Affiliations

  1. Department of Urology, Lviv National Medical University n.a. Danylo Halytsky, Pekarska Str. 69, Lviv, Ukraine

    Yulian Mytsyk, Serhiy Pasichnyk & Dmytro Vorobets

  2. Medical center “Euroclinic”, Lviv, Ukraine

    Ihor Dutka

  3. Department of Radiology, Lviv National Medical University n.a. Danylo Halytsky, Lviv, Ukraine

    Ihor Dats

  4. Department of Urology, Centre of Postgraduate Medical Education, Warsaw, Poland

    Michał Skrzypczyk

  5. Department of Postgraduate Education and Research, Kazakhstan Medical University, Almaty, Kazakhstan

    Yerzhan Uteuliyev

  6. Faculty of Health and Social Work, Trnava University, Trnava, Slovakia

    Andrea Botikova

  7. Department of General Medicine, Faculty of Medicine, Slovak Medical University, Limbova 12, 8303, Bratislava, Slovakia

    Katarina Gazdikova

  8. Department of Medical Biology, Jessenius Faculty of Medicine in Martin, Comenius University, Martin, Slovakia

    Peter Kubatka

  9. Department of Gynaecology and Obstetrics, Faculty of Medicine, Pavol Jozef Safarik University and Louis Pasteur University Hospital, Tr. SNP 1, 04001, Kosice, Slovakia

    Peter Urdzik

  10. Department of Internal Medicine, Brothers of Mercy Hospital, Polni 553/3, 63900, Brno, Czech Republic

    Peter Kruzliak

Authors
  1. Yulian Mytsyk
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  2. Serhiy Pasichnyk
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  3. Ihor Dutka
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  4. Ihor Dats
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  5. Dmytro Vorobets
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  6. Michał Skrzypczyk
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  7. Yerzhan Uteuliyev
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  8. Andrea Botikova
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  9. Katarina Gazdikova
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  10. Peter Kubatka
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  11. Peter Urdzik
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  12. Peter Kruzliak
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Correspondence to Peter Kruzliak.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Mytsyk, Y., Pasichnyk, S., Dutka, I. et al. Systemic treatment of the metastatic renal cell carcinoma: usefulness of the apparent diffusion coefficient of diffusion-weighted MRI in prediction of early therapeutic response. Clin Exp Med 20, 277–287 (2020). https://doi.org/10.1007/s10238-020-00612-9

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  • DOI: https://doi.org/10.1007/s10238-020-00612-9

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