Predictive Value Of Pelvic Bone Marrow ADC Value Based On MRI And Clinical Factors For Bone Marrow Suppression In Concurrent Chemoradiotherapy For Cervical Cancer

Objective:To investigate the predictive value of pelvic bone marrow ADC value based on MRI and clinical factors for bone marrow suppression（BMS）in patients with concurrent chemoradiotherapy（CCRT）for cervical cancer.Methods:This study included 120 patients with locally advanced cervical cancer（LACC）who underwent CCRT in our institution from January 2016 to December 2018.According to the status of BMS during CCRT,they were divided into Ⅰ-Ⅱ and Ⅲ-Ⅳ grade BMS groups,and the related clinical and imaging factors were analyzed retrospectively.The clinical factors included patient’s age,menopause status,FIGO stage,body mass index（BMI）,chemotherapy regimen and chemotherapy cycle.The chemotherapy regimen included paclitaxel+cisplatin（TP）,paclitaxel+carboplatin（TC）,docetaxel+cisplatin（DP）.The imaging factor was ADC value of pelvic bone marrow.The measurement of ADC value of pelvic bone marrow was based on T2WI sequence.On the ADC image,a radiologist drew the region of interest（ROI）at the signal uniformity of both sides of pubis and ischia through the central layer of femoral head and its adjacent layers,measured the ADC value,and then took the average value as the ADC value of pelvic bone marrow.The statistical analysis was performed by SPSS 26.0 software.Chi-square test was used to compare the differences of clinical factors between the groups of patients with grade Ⅰ-Ⅱ and grade Ⅲ-Ⅳ BMS.Kolmogorov-Smirnov test was used to analyze whether ADC values of pelvic bone marrow were in accordance with normal distribution.Mann-Whitney U test was used to analyze the differences between the groups of patients with grade Ⅰ-Ⅱ and grade Ⅲ-Ⅳ BMS which did not conform to the normal distribution,while independent-samples T test was used to analyze the differences between the ADC values of pelvic bone marrow of patients with Ⅰ-Ⅱ and Ⅲ-Ⅳ grade BMS which conformed to the normal distribution.Then receiver operating characteristic（ROC） curve was used to analyze the diagnostic efficacy of pelvic bone marrow ADC value in predicting grade Ⅲ-Ⅳ BMS during CCRT.Results:1.120 patients with LACC developed different degrees of BMS during CCRT.And there were 66 patients with grade Ⅲ-Ⅳ BMS,among which 17 patients in the premenopausal group and 49 patients in the postmenopausal group.2.Overall,there were significant differences in menopause status（P=0.011）, chemotherapy regimen（P=0.012）and pelvic bone marrow ADC value（P<0.001）among patients with grade Ⅰ-Ⅱ and grade Ⅲ-Ⅳ BMS,but there were no significant differences in patient’s age（P=0.219）,FIGO stage（P=0.575）,BMI（P=0.579）and chemotherapy cycle（P=0.292）.And the incidence of grade Ⅲ-Ⅳ BMS was the highest in patients receiving TP regimen（70.59%）.ROC analysis showed that the threshold value of ADC value of pelvic bone marrow was 0.381×10^-3 mm²/s,area under curve（AUC）=0.689,which means that patients with ADC value of pelvic bone marrow lower than 0.381×10^-3 mm²/s before CCRT were more likely to develop grade Ⅲ-Ⅳ BMS,the sensitivity of which was 46.30%,and the specificity was84.80%.3.There were significant differences in chemotherapy regimens（P=0.008）and ADC value of pelvic bone marrow（P<0.001）among premenopausal patients with grade Ⅰ-Ⅱ and Ⅲ-Ⅳ BMS,but no significant differences in patient’s age（P=1.000）,FIGO stage（P=0.722）,BMI（P=0.563）and chemotherapy cycle（P=0.411）.And the incidence of grade Ⅲ-Ⅳ BMS was the highest in patients receiving TP regimen（71.43%）.ROC analysis showed that the threshold value of ADC value of pelvic bone marrow was0.405×10^-3 mm²/s,area under curve（AUC）=0.833,which means that premenopausal patients with ADC value of pelvic bone marrow lower than 0.405×10^-3 mm²/s before CCRT were more likely to develop grade Ⅲ-Ⅳ BMS,the sensitivity of which was88.50%,and the specificity was 76.50%.4.There were no significant differences in patient’s age（P=0.632）,FIGO stage（P=0.731）,BMI（P=0.761）,chemotherapy regimen（P=0.410）,chemotherapy cycle（P=0.820）and ADC value of pelvic bone marrow（P=0.309）among menopausal patients with grade Ⅰ-Ⅱ and Ⅲ-Ⅳ BMS.Conclusion:1.In general,the patients with postmenopausal status,receiving TP regimen and ADC value of pelvic bone marrow lower than 0.381×10^-3 mm²/s were more likely to develop grade Ⅲ-Ⅳ BMS,but the diagnostic efficacy of pelvic bone marrow ADC threshold was poor.2.The premenopausal patients with receiving TP regimen and ADC value of pelvic bone marrow lower than 0.405×10^-3 mm²/s were more likely to develop grade Ⅲ-Ⅳ BMS,and the pelvic bone marrow ADC threshold had higher diagnostic efficiency.3.In this study,ADC value of pelvic bone marrow and related clinical factors can not be used to assess the risk of grade Ⅲ-Ⅳ BMS in postmenopausal patients with LACC during CCRT.