Abstract
Background The accurate prediction of prognosis is key to prompt therapy adjustment. The purpose of our study was to investigate the efficacy of diffusion kurtosis imaging (DKI) in predicting progression-free survival (PFS) and overall survival (OS) in osteosarcoma patients with preoperative chemotherapy. Methods Thirty patients who underwent DKI before and after chemotherapy, followed by tumor resection, were retrospectively enrolled. The patients were grouped into good responders (GRs) and poor responders (PRs). The Kaplan-Meier and log-rank test were used for survival analysis. The association between the DKI parameters and OS and PFS was performed by univariate and multivariate Cox proportional hazards models. Results Significantly worse OS and PFS were associated with a lower mean diffusivity (MD) after chemotherapy (HR, 5.8; 95% CI, 1.5-23.1; P = 0.012 and HR, 3.5; 95% CI, 1.2-10.1: P = 0.028, respectively) and a higher mean kurtosis (MK) after chemotherapy (HR, 0.3; 95% CI, 0.1-0.9; P = 0.041 and HR, 0.3; 95% CI, 0.1-0.8; P = 0.049, respectively). Likewise, shorter OS and PFS were also significantly associated with a change rate in MD (CR MD) of less than 13.53% (HR, 8.6; 95% CI, 1.8-41.8; P = 0.007 and HR, 2.9; 95% CI, 1.0-8.2; P = 0.045, respectively). Compared to GRs, PRs had an approximately 9- and 4-fold increased risk of death (HR, 9.4; 95% CI, 1.2-75; P = 0.034) and progression (HR, 4.2; 95% CI, 1.2-15; P = 0.026), respectively. Conclusions DKI has a potential to be a prognostic tool in osteosarcoma. Low MK and high MD after chemotherapy or high CR MD indicates favorite outcome, while prospective studies with large sample sizes are warranted.
Highlights
Osteosarcoma is one of the most common primary malignant bone tumors in children and adolescents, and approximately 75-80% of osteosarcoma involves appendicular bone [1]
We found that better overall survival (OS) and progression-free survival (PFS) were associated with higher values of post mean diffusivity (MD) and with lower values of post mean kurtosis (MK).change rate in MD (CR MD) greater than or equal to 13.5% was significantly associated with longer OS and PFS
We evaluated the combined effect of post MK and post MD on survival; we found that the patients with post MK ≥ 0:80 and post MD < 1:66 mm2/s × 10−3 and other parameters had approximately 5 and 3 times higher risk of OS compared with the patients with post MK < 0:80 and post MD ≥ 1:66 mm2/s × 10−3, the association did not reach statistical significance for patients in group 3
Summary
Osteosarcoma is one of the most common primary malignant bone tumors in children and adolescents, and approximately 75-80% of osteosarcoma involves appendicular bone [1]. The importance of preoperative neoadjuvant chemotherapy in the treatment of osteosarcoma has been confirmed, and effective chemotherapy has dramatically improved patient survival rates, contributing to a 5-year survival rate increase from 20% to 70% [2]. Increasing evidence has shown that chemotherapy-induced tumor necrosis is the strongest known predictive indicator for survival [3, 4]. The early identification of chemotherapy response is key to prompting treatment regimen adjustments, as ineffective chemotherapy has the potential to increase the risk of complications and mortality or form resistant clones [5]. The purpose of our study was to investigate the efficacy of diffusion kurtosis imaging (DKI) in predicting progression-free survival (PFS) and overall survival (OS) in osteosarcoma patients with preoperative chemotherapy. Low MK and high MD after chemotherapy or high CR MD indicates favorite outcome, while prospective studies with large sample sizes are warranted
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