| Objective : Cementoplasty is widely used in malignant bone disease,in which percutaneous vertebroplasty(PVP)is widely used in clinic and has good analgesic effect,but the effect of bone cement on tumor is unclear.Among the many potential complications,local bone-destruction-progression(LBDP)is a long-term situation that is easily overlooked.In addition,there is currently no uniform standard for evaluating bone cement distribution.This study reviewed the relevant clinical and imaging data of patients undergoing PVP surgery,proposed a reasonable and simple way to evaluate bone cement distribution,established animal models of bone metastasis,simulated the process of bone cement injection and other animal experiments,combined with imaging features and immunohistochemical indicators,to explore the risk factors for the formation of LBDP,and the effect of bone cement on tumor tissue in vivo.Methods: 1.Review the clinical data of patients undergoing PVP surgery due to vertebral body metastasis in Shengjing Hospital of China Medical University from October 2012 to October 2019,including sex,age,lesion characteristics,and visual simulation before and after surgery Table(VAS),cement dosage,etc.,as well as the scores of the imaging data for evaluating the distribution of bone cement,one is the Saliou score,and the other is the original score of the author,that is,the bone cement filling rate.Statistical methods include independent sample t-test to compare continuous variables,?2 test or Fisher's exact test to evaluate categorical data,single-factor Logistic regression analysis to determine the potential predictors of LBDP,and input of P-value variables of <0.05 into multiple logistic regression analysis to detect Its independence.Regression analysis and receiver operating characteristic curve(ROC)analysis were used to determine the critical value for predicting the fill rate of LBDP at 6 months after surgery.P<0.05 is statistically significant.The correlation coefficient between filling rate and saliou score was calculated by Pearson correlation analysis,and the consistency between them was analyzed by Bland-Altman plots.2.By making animal bone metastasis models,simulating puncture implantation of bone cement(10-12 days for tumor seeding),and scanning MR at 2 time points after bone cement injection(immediately,7-9 days),obtain bone metastasis pathological tissues,After immunohistochemical staining,the MR parameters(D,D*,f,ADC,PDFF)and immunohistochemical indicators(HIF-1?,Ki67,PCNA,VEGF)were analyzed by Image J software.The positive signal of immunohistochemistry measures the percentage of positive signal(% area)of each image separately.The statistical method includes two independent sample t-tests,and the receiver operating characteristic curve(ROC curve)is used to evaluate the diagnostic efficacy of each parameter;Spearman correlation analyzes the correlation between MR parameters and immunohistochemical indexes.Results: 1.This retrospective study divided 48 patients and 54 vertebrae into two groups.The LBDP in group A was less than 6 months(n=41),and the LBDP in group B was more than 6 months(n=13).The preoperative and postoperative VAS of the two groups were significantly reduced.The complete filling amount of bone cement and bone cement in group B was much higher than that in group A(2.85±0.97 VS.4.12±1.77;P=0.027),and group B suffered from pain again The time was significantly better than that of group A 8.46±2.73 VS.3.39±1.63;P=0.0001.The Saliou score and fill rate of the two groups were statistically different(11.77±3.17 VS.9.34±3.28,P=0.023;0.752±0.227 VS.0.489±0.161,P<0.0001).Single factor Logistic analysis showed that the complete cement filling,cement dosage,Saliou score and filling rate were statistically significant in predicting LBDP.Multivariate logistic analysis showed that fill rate was an independent predictor of LBDP within 6 months of vertebral metastasis(concession ratio[OR]: <0.001,95% confidence interval [CI]: <0.001-0.006,P=0.0007).The tangent value of the filling rate calculated according to ROC analysis is 0.646,the sensitivity is85.4%,and the specificity is 84.6%.And between the two groups,6-month LBDP was the most significant factor.Compared with ? 0.646 group,the proportion of LBDP in > 0.646 group was lower(97.22% VS.55.56%,P<0.0001).The correlation Pearson coefficient between filling rate and saliou score /18 was 0.578(P<0.0001),and mean and Lo A via the Bland-Altman analysis for cement filling was 0.184 [Lo A:-0.3596;0.3616].2.The femoral metastasis model was successfully established,a total of 24(success rate100%,survival rate 100%),scan MR to obtain parameters such as IVIM and PDFF,the D value and ADC value of the two groups were statistically different(P=0.0112,0.0131).According to the relationship between the location of the pathological tissue and the bone cement,the experimental components were divided into <3mm and >3mm,and the immunohistochemical indexes of the >3mm group were not statistically different from the control group.The immune tissue indexes of the experimental group(<3mm)were statistically different between Ki67 and VEGF(P=0.0307,0.006).The difference in ROC of ADC value is statistically significant(P=0.0067),the area under the curve AUC value is 0.8264,the 95% confidence interval CI(0.6573-0.9955),the tangent value of ADC value is 1.248,sensitivity and specificity are respectively They are 58.33% and 100.00%.The difference in ROC between Ki67 and VEGF was statistically significant(P=0.0327,0.0094),and the AUC values were 0.7569,95% CI(0.5599-0.9540),0.8125,95% CI(0.6253-0.9997),respectively.D value is positively correlated with HIF-1?(r=0.5835,P=0.0028),negatively correlated with Ki67(r=-0.8316,P<0.0001),and negatively correlated with PCNA(r=-0.9437,P<0.0001),There was no correlation with VEGF(r=-0.1996,P=0.3498).ADC value is negatively correlated with PCNA(r=-0.4084,P=0.0475),has no correlation with HIF-1?(r=0.1062,P=0.6215),and has no correlation with Ki67(r=-0.3335,P=0.1113),No correlation with VEGF(r=-0.1118,P=0.6030).Conclusion: Bone cement dose,complete cement filling,Saliou score and filling rate were associated with LBDP within 6 months,and patients with low filling rate were more likely to have LBDP in the early stage.IVIM-MR has a certain diagnostic value in this model.In a short period of time,the effect of bone cement on tumor tissue killing and proliferation inhibition is limited. |
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