| Objective: To investigate the prognostic value of the apparent diffusion coefficient(ADC),which is quantization of diffusion-weighted imaging(DWI)in predicting clinical outcome in patients with locally advanced cervical cancer cervical cancer after concurrent chemoradiotherapy(CCRT).Methods: The clinicopathological and follow-up data of patients with locally advanced cervical cancer who underwent radical concurrent chemoradiotherapy for the first time from January 2015 to December 2018 and underwent 3T MRI examination before treatment and 1 month after treatment at the affiliated cancer hospital of guang xi medical university were collected.To analyze the relationship between the mean ADC value of cervical cancer before treatment and the clinicopathological features.The percentage change rate of the mean ADC value(△ADC)was calculated from the mean apparent diffusion coefficient(ADC)value of the cervical cancer before and after treatment.Receiver operating characteristic curve(ROC)was drawn to obtain the optimal cut-off point of △ADC.According to the optimal cut-off value,the subjects were divided into high △ADC group and low △ADC group.The relationship between△ADC and clinical characteristics was analyzed.Kaplan-Meier was used to draw survival curves.The difference analysis is performed by log-rank test(log-rank test).Cox regression model was used to analyze the factors affecting local regional control(LRC),progression free survival(PFS)and overall survival(OS)of locally advanced cervical patients.Results:1.During a median follow-up period of 27 months(range,4-58 months),16patients(11.8%)deceased,Disease progression occurred in 27(19.9%)patients.Patients who under local regional uncontrolled were 15(11%).The 1-year cumulative LRC was 92.6%,and the 3-year cumulative LRC was 88.5%.The 1-year cumulative PFS was 91.9%,and the 3-year cumulative PFS was 84.3%.The1-year cumulative OS was 97.8%,and the 3-year cumulative OS was 89.7%.2.The ADC value of cervical cancer before treatment was correlated with pathological type and differentiation degree,and the difference was statistically significant.(P < 0.05)3.The ROC curve results of the prognosis and outcome of local advanced cervical cancer after concurrent chemoradiotherapy of △ADC showed that the area under the ROC curve was 0.849(95%CI: 0.760-0.937,p<0.0001).The optimal truncation value was 27.49%,Se: 0.875,Sp: 0.742,and the youden index was 0.617.Taking 27.49% as the critical value,136 patients were divided into low△ADC group(△ADC≤27.49%)and high △ADC group(△ADC> 27.49%).4.△ADC was closely correlated with pathological type and lymph node metastasis(P < 0.05).There was no correlation between △ADC and locally advanced cervical cancer age,clinical stage,differentiation degree,tumor diameter,SCC-Ag and hemoglobin level before treatment(p >,0.05)5.The 3-year LRC in low △ADC group(△ADC ≤ 27.49%)were 71.9%.The 3-year LRC in the high △ADC group(△ADC>27.49%)were 96.7%.The difference was statistically significant(P<0.0001).Univariate Cox model analysis showed that pathological type,lymph node metastasis,radiotherapy time and delta ADC were the risk factors affecting LACC patients’ PFS,all of which were statistically significant(P < 0.05).Multivariate Cox analysis showed that radiotherapy time(HR=5.249,95CI: 1.139-24.186,P=0.033)and △ADC(HR=0.230,95CI: 0.058-0.903,P =0.035)were all independent prognostic factors affecting LACC patients’ LRC.6.The 1-year PFS and 3-year PFS in low △ADC group(△ADC≤27.49%)were 70.9% and 59.2% respectively.The 1-year PFS and 3-year PFS in the high△ADC group(△ADC>27.49%)were 92.2% and 90.9%,respectively.The difference was statistically significant(P<0.0001).Univariate Cox model analysis showed that pathological type,lymph node metastasis,SCC-Ag,radiotherapy time and delta ADC were the risk factors affecting LACC patients’ PFS,all of which were statistically significant(P<0.05).Multivariate Cox analysis showed that lymph node metastasis(HR=2.744,95CI: 1.018-7.401,P=0.046),radiotherapy time(HR=2.657,95CI: 1.134-6.226,P=0.025),SCC-Ag(HR=3.788,95CI:1.041-13.789,P=0.043),and △ADC(HR=0.379,95 CI:0.157-0.912,P =0.03)were all independent prognostic factors affecting LACC patients’ PFS.7.The actuarial OS was worse in patients with ΔADC≤27.49% than in those with ΔADC>27.49%,with a 3-year survival rate of 55.2% compared with96.3%.The difference was statistically significant(P<0.001).Univariate Cox model analysis showed that pathological type,lymph node metastasis,hemoglobin level before treatment,radiotherapy time and △ADC were risk factors affecting LACC patients’ OS,all of which were statistically significant(P<0.05).Multivariate Cox analysis showed that lymph node metastasis(HR=4.356,95CI:1.111-28.624,P =0.037),Hb(HR=0.286,95CI: 0.087-0.932,P =0.038),and△ADC(HR=0.083,95CI: 0.017-0.404,P =0.002)were all independent risk factors affecting LACC patients’ OS.Conclusion:1.The ADC value of cervical cancer before treatment is closely related to pathological type and differentiation degree.ADC values before treatment may be used as an adjunct to evaluate the pathologic features of cervical cancer.2.△ADC value was closely related to pathological type and lymph node metastasis of cervical cancer.3.The local regional control time of patients with locally advanced cervical cancer is related to pathological type,lymph node metastasis,radiotherapy time and △ADC.Radiotherapy time and △ADC were independent risk factors affecting LRC.4.The progression free survival time of patients with locally advanced cervical cancer is related to pathological type,lymph node metastasis,radiotherapy time,SCC-Ag and △ADC.Lymph node metastasis,radiotherapy time,SCC-Ag and △ADC were independent risk factors affecting PFS.5.The overall survival time of patients with locally advanced cervical cancer is related to pathological type,lymph node metastasis,hemoglobin level,radiotherapy time and △ADC.Patients with locally advanced cervical cancer with△ADC < 27.49 % have poor prognosis.6.The percentage change in tumor ADC may be a useful predictor of local regional control,progression free survival and overall survival in patients with locally advanced cervical cancer treated with concurrent chemoradiotherapy.Individualized applications may require multicentre,additional samples,and further studies with long-term follow-up of more than 5 years. |
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