Prognostic model based on magnetic resonance imaging, whole-tumour apparent diffusion coefficient values and HPV genotyping for stage IB-IV cervical cancer patients following chemoradiotherapy.

Abstract

OBJECTIVES:

To develop and validate a prognostic model of integrating whole-tumour apparent diffusion coefficient (ADC) from pretreatment diffusion-weighted (DW) magnetic resonance (MR) imaging with human papillomavirus (HPV) genotyping in predicting the overall survival (OS) and disease-free survival (DFS) for women with stage IB-IV cervical cancer following concurrent chemoradiotherapy (CCRT).

METHODS:

We retrospectively analysed three prospectively collected cohorts comprising 300 patients with stage IB-IV cervical cancer treated with CCRT in 2007-2014 and filtered 134 female patients who underwent MR imaging at 3.0 T for final analysis (age, 24-92 years; median, 54 years). Univariate and multivariate Cox regression analyses were used to evaluate the whole-tumour ADC histogram parameters, HPV genotyping and relevant clinical variables in predicting OS and DFS. The dataset was randomly split into training (n = 88) and testing (n = 46) datasets for construction and independent bootstrap validation of the models.

RESULTS:

The median follow-up time for surviving patients was 69 months (range, 9-126 months). Non-squamous cell type, ADC10 <0.77 × 10-3 mm2/s, T3-4, M1 stage and high-risk HPV status were selected to generate a model, in which the OS and DFS for the low, intermediate and high-risk groups were significantly stratified (p < 0.0001). The prognostic model improved the prediction significantly compared with the International Federation of Gynaecology and Obstetrics (FIGO) stage for both the training and independent testing datasets (p < 0.0001).

CONCLUSIONS:

The prognostic model based on integrated clinical and imaging data could be a useful clinical biomarker to predict OS and DFS in patients with stage IB-IV cervical cancer treated with CCRT.

KEY POINTS:

• ADC 10 is the best prognostic factor among ADC parameters in cervical cancer treated with CCRT • A novel prognostic model was built based on histology, ADC 10 , T and M stage and HPV status • The prognostic model outperforms FIGO stage in the survival prediction.

• Authors: Gigin Lin, Lan-Yan Yang, Yu-Chun Lin, Yu-Ting Huang, Feng-Yuan Liu, Chun-Chieh Wang, Hsin-Ying Lu, Hsin-Ju Chiang, Yu-Ruei Chen, Ren-Chin Wu, Koon-Kwan Ng, Ji-Hong Hong, Tzu-Chen Yen, Chyong-Huey Lai
• Journal: European radiology (Eur Radiol) Vol. 29 Issue 2 Pg. 556-565 (Feb 2019) ISSN: 1432-1084 [Electronic] Germany
• PMID: 30051142 (Publication Type: Journal Article)

Topics

• Adult
• Aged
• Aged, 80 and over
• Chemoradiotherapy (methods)
• Diffusion Magnetic Resonance Imaging (methods)
• Female
• Genotype
• Genotyping Techniques (methods)
• Humans
• Image Interpretation, Computer-Assisted (methods)
• Kaplan-Meier Estimate
• Middle Aged
• Neoplasm Staging
• Papillomaviridae (classification, genetics)
• Prognosis
• Retrospective Studies
• Uterine Cervical Neoplasms (diagnostic imaging, pathology, therapy, virology)
• Young Adult