Abstract
BackgroundTo explore prognostic value of the pre-treatment primary lesion apparent diffusion coefficient (ADC) in locoregionally advanced nasopharyngeal carcinoma (LA-NPC).MethodsA total of 843 patients with newly diagnosed LA-NPC were enrolled from January 2011 to April 2014 and divided into two groups based on ADC values: the low-ADC group and high-ADC group. The 3-year local relapse-free survival (LRFS), distant metastasis free survival (DMFS), disease-free survival (DFS) and overall survival (OS) rates between two groups were compared using Kaplan-Meier curve, and Cox regression analyses were performed to test prognostic value of the pretreatment ADC in LA-NPC.ResultsThe cut-off value of the pretreatment ADC for predicting local relapse was 784.5 × 10− 6 mm2/s (AUC [area under curve] = 0.604; sensitivity = 0.640; specificity = 0.574), thus patients were divided into low-ADC (< 784.5 × 10− 6; n = 473) group and high-ADC (≥784.5 × 10− 6; n = 370) group. The low-ADC group had significantly higher 3-year LRFS rate and DFS rate than the high-ADC group (LRFS: 96.2% vs. 91.4%, P = 0.003; DFS: 81.4% vs. 73.0%, P = 0.0056). Multivariate analysis showed that the pretreatment ADC is an independent prognostic factor for LRFS (HR, 2.04; 95% CI, 1.13–3.66; P = 0.017) and DFS (HR, 1.41; 95% CI, 1.04–1.89; P = 0.024).ConclusionsThe pretreatment ADC of the primary lesion is an independent prognostic factor for LRFS and DFS in LA-NPC patients.
Highlights
To explore prognostic value of the pre-treatment primary lesion apparent diffusion coefficient (ADC) in locoregionally advanced nasopharyngeal carcinoma (LA-Nasopharyngeal carcinoma (NPC))
Apparent diffusion coefficient (ADC) is obtained from diffusion weighted magnetic resonance imaging (MRIDWI) after processing, and it is a functional parameter that mainly reflects the Brownian motion of water molecules
Patients were included in this study if they meet the following inclusion criteria: (i) karnofsky performance score (KPS) ≥ 70; (ii) newly diagnosed stage III-IVA NPC [18]; (iii) receiving intensity-modulated radiotherapy (IMRT); (iv) the interval between Magnetic resonance imaging (MRI) examination and the beginning of treatment was less than 28 days; (v) all patients underwent examination by the same MRI machine (Trio Tim; Siemens, Erlangen Germany) including diffusion-weighted images (DWI) (b values: 0, 1000 s/ mm2)
Summary
To explore prognostic value of the pre-treatment primary lesion apparent diffusion coefficient (ADC) in locoregionally advanced nasopharyngeal carcinoma (LA-NPC). With regard to NPC, high pretreatment ADC of the primary lesion has been shown to predict poor outcomes and poor response to radio-sensitivity [16, 17]. These studies obtained relatively small sample size, resulting in inconclusive results. Given the challenging treatment strategy and poor outcome of local failure, it’s worth evaluating the role of the pretreatment ADC in predicting local failure We did this retrospective study to investigate this issue in order to categorize patients and administrate individualized treatment among locoregionally advanced NPC (LA-NPC) patients
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