Predictive Value Of Multiparameter Magnetic Resonance Imaging And Clinical Prognostic Factors On The Early Efficacy Of Concurrent Chemoradiotherapy For Cervical Squamous Cell Carcinoma

ObjectiveTo investigate the application value of multiparameter magnetic resonance imaging（mp MRI）and clinical prognostic factors（CPF）in the prediction of the early efficacy of concurrent chemoradiotherapy（CCRT）for cervical cancer.MethodsCollected 85 newly diagnosed patients with cervical cancer who were pathologically confirmed at the Provincial Hospital Affiliated to Anhui Medical University from November 2017 to January 2020.The clinicopathological characteristics of patients were collected and sorted out:age,tumor size,squamous cell carcinoma antigen（SCC）,Federation International of Gynecology and Obstetrics（FIGO）staging,lymph node metastasis,pathological classification.All patients underwent intravoxel incoherent motion diffusion weighted imaging（IVIM-DWI）and dynamic contrast-enhancement magnetic resonance imaging（DCE-MRI）scans within 2 weeks before CCRT.The data collected from MRI scans were transferred to the workstation for processing,and the IVIM-DWI quantitative parameters（ADC,D,D*,f）and DCE-MRI quantitative parameters(K^trans,K_ep,V_e,V_p)of all patients were measured.MRI re-examination was performed one month after the end of CCRT,and the patients were divided into complete remission（CR）group and non-CR group according to the response evaluation criteria in solid tumors（RECIST）and lymph node metastasis.The CR group included patients with complete remission of the primary tumor without lymph node metastasis,and the rest belonged to the non-CR group.The t test and Mann-Whitney U test were used to analyze whether the CPF,IVIM-DWI and DCE-MRI quantitative parameters of the two groups were statistically different before CCRT.Multivariate logistic regression analysis was used to screen out independent prognostic factors related to the early efficacy of CCRT for cervical cancer,and a predictive model was established.By drawing receiver operating characteristic（ROC）curves,the effectiveness of mp MRI and CPF in predicting the early efficacy of CCRT for cervical cancer,and the effectiveness of mp MRI and CPF in combination prediction were compared.Results1.Efficacy grouping:A total of 85 patients were included in the study.One month after the end of CCRT,according to the RECIST criteria and lymph node metastasis,52patients were in the CR group and 33 patients were in the non-CR group.2.Comparison of CPF between CR group and non-CR group:Univariate analysis showed that before CCRT,FIGO staging was significantly different between CR group and non-CR group（P<0.05）,while other CPF（maximum tumor diameter,SCC,lymph node metastasis,pathological type）showed no statistical difference（P>0.05）.3.Comparison of parameters between CR group and non-CR group:Univariate analysis showed that before CCRT,ADC,D and V_e values of CR group were lower than those of non-CR group,with statistically significant differences（P<0.05）;f and K^trans values were higher than those of non-CR group,with statistically significant differences（P<0.05）;other parameters(D*,K_ep,V_p)showed no statistically significant differences（P>0.05）.4.Prediction of efficacy:Multivariate analysis showed that D,K^trans,V_e values and FIGO staging were independent prognostic factors for the early efficacy of CCRT for cervical cancer.The area under curve（AUC）were 0.763,0.813,0.765,0.722,respectively,and the combined predicted AUC of D,K^trans,and V_e was 0.912,and its sensitivity and specificity were 90.9%and 90.4%,respectively.The combined predicted AUC of D,K^trans,V_e and FIGO staging was 0.940,and its sensitivity and specificity were 84.8%and 96.2%,respectively.According to the cutoff value obtained by the ROC curve,D>0.613,K^trans<0.585,V_e>0.593 were defined as risk factors,and patients are divided into ultra-low risk group（no risk factor）,low-risk group（1 risk factor）,and medium-risk group（2 risk factors）and high-risk group（3 risk factors）,the probability of residual tumor or lymph node metastasis one month after the end of CCRT was 0%,5%,71%,and 100%.Furthermore,FIGO stage III-IV was defined as a risk factor.Compared with stage I-II,the probability of residual tumor or lymph node metastasis in the low-risk group and the middle-risk group can be increased from 0%and 22%to 11%and 91%,respectively.Conclusions1.Before treatment,IVIM-DWI quantitative parameter D value,DCE-MRI quantitative parameter K^trans,V_e values and FIGO staging have certain predictive value for the early effect of CCRT for cervical cancer,and the combined application of mp MRI and CPF can improve the predictive performance of the early efficacy of CCRT for cervical cancer.2.IVIM-DWI and DCE-MRI related parameters can reflect functional information such as the diffusion of water molecules and blood perfusion in cervical cancer tumor tissue.It is a non-invasive imaging technology that predicts the therapeutic effect from a microscopic perspective.Its combined application with CPF is expected to become a new method for predicting the early efficacy of CCRT for cervical cancer.