Abstract

The focus of this study is the development of a statistical modelling procedure for characterising intra-tumour heterogeneity, motivated by recent clinical literature indicating that a variety of tumours exhibit a considerable degree of genetic spatial variability. A formal spatial statistical model has been developed and used to characterise the structural heterogeneity of a number of supratentorial primitive neuroectodermal tumours (PNETs), based on diffusion-weighted magnetic resonance imaging. Particular attention is paid to the spatial dependence of diffusion close to the tumour boundary, in order to determine whether the data provide statistical evidence to support the proposition that water diffusivity in the boundary region of some tumours exhibits a deterministic dependence on distance from the boundary, in excess of an underlying random 2D spatial heterogeneity in diffusion. Tumour spatial heterogeneity measures were derived from the diffusion parameter estimates obtained using a Bayesian spatial random effects model. The analyses were implemented using Markov chain Monte Carlo (MCMC) simulation. Posterior predictive simulation was used to assess the adequacy of the statistical model. The main observations are that the previously reported relationship between diffusion and boundary proximity remains observable and achieves statistical significance after adjusting for an underlying random 2D spatial heterogeneity in the diffusion model parameters. A comparison of the magnitude of the boundary-distance effect with the underlying random 2D boundary heterogeneity suggests that both are important sources of variation in the vicinity of the boundary. No consistent pattern emerges from a comparison of the boundary and core spatial heterogeneity, with no indication of a consistently greater level of heterogeneity in one region compared with the other. The results raise the possibility that DWI might provide a surrogate marker of intra-tumour genetic regional heterogeneity, which would provide a powerful tool with applications in both patient management and in cancer research.

Highlights

  • Numerous investigations have demonstrated a surprising level of intra-tumour heterogeneity in a variety of cancers[1,2,3]

  • The first subsection reports the main findings of the tumour spatial heterogeneity analysis, which compares the level of heterogeneity observed in the core and boundary region of five tumours

  • Particular attention is paid to heterogeneity close to the tumour boundary, in order to determine whether water diffusivity in the boundary region of some tumours exhibits a deterministic dependence on distance from the boundary

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Summary

Introduction

Numerous investigations have demonstrated a surprising level of intra-tumour heterogeneity in a variety of cancers[1,2,3]. Tumour growth is conceived as a Darwinian process in which spatially heterogeneous mutations occur. The implications are enormous, and intra-tumour heterogeneity poses challenges and questions for those searching for effective treatments. It has been suggested that drug resistance is an inevitable consequence of intra-tumour genetic diversity, and that the presence of many different genomes increases the probability that a particular population of cells develop resistance. It is suggested that a given drug might kill a majority of tumour cells, leaving those that are resistant to become dominant in a Darwinian-like selection processes. According to this proposition, selection is driven by the treatment itself. The realisation that treatment can drive the evolutionary process might indicate a need to revise current treatment strategies[4]

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