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    ASL-MRI对局部晚期鼻咽癌诱导化疗反应及近期疗效的早期预测价值

    Early prediction value of ASL-MRI for induced chemotherapy response and short-term efficacy of locally advanced nasopharyngeal carcinoma

      摘要
    • 摘要: 目的： 通过动脉自旋标记磁共振成像（ASL-MRI）监测局部晚期鼻咽癌（LA-NPC）诱导化疗前、后的肿瘤血流量（TBF），探讨ASL-MRI早期预测LA-NPC诱导化疗反应及近期疗效的价值。方法： 收集38例初诊LA-NPC患者，于诱导化疗前、后行ASL-MRI，以获得诱导化疗前TBF（Pre-TBF）和诱导化疗后TBF（Post-TBF），并计算诱导化疗前、后的TBF变化值（ΔTBF）及变化率（ΔTBF%）。在诱导化疗后，将完全缓解（CR）和部分缓解（PR）归为反应组，疾病稳定（SD）及疾病进展（PD）归为非反应组。在放疗后3个月评估近期疗效，分为CR组和非CR组（PR、SD及PD）。采用单因素及多因素二分类logistic回归分析TBF参数对诱导化疗效果及近期疗效的影响。采用受试者工作特性（ROC）曲线确定诊断效能。结果： 38例患者中诱导化疗反应组23例（60.5%），非反应组15例（39.5%）。放疗后3个月CR组22例（57.9%），非CR组16例（42.1%）。诱导化疗反应组在放疗后3个月的CR率显著高于非反应组（73.9% vs.33.3%，P=0.02）。38例患者Pre-TBF显著高于Post-TBF（Z＝4.227，P＜0.001）。诱导化疗反应组Pre-TBF、ΔTBF及ΔTBF%显著高于非反应组（均P＜0.05）；放疗后3个月CR组的Pre-TBF、ΔTBF及ΔTBF%显著高于非CR组（均P＜0.05）。多因素二分类logistic回归结果显示，Pre-TBF是诱导化疗效果的独立影响因素（P=0.027），ROC曲线下面积为0.745（P=0.012）；T分期及ΔTBF%是近期疗效的独立影响因素（均P＜0.05），ΔTBF%的ROC曲线下面积为0.807（P=0.001）。结论： 治疗前LA-NPC肿瘤血流高灌注提示更好的疗效，Pre-TBF可以预测LA-NPC诱导化疗效果，ΔTBF%可以预测LA-NPC近期疗效。

       

      Abstract: Objective: To monitor tumor blood flow (TBF) before and after induction chemotherapy in locally advanced nasopharyngeal carcinoma (LA-NPC) by arterial spin labeling magnetic resonance imaging (ASLMRI), and to investigate the value of ASL-MRI in early predicting response of induction chemotherapy and shortterm efficacy in LA-NPC. Methods: Thirty-eight newly diagnosed LA-NPC patients were enrolled. ASL-MRI were performed both before and after induction chemotherapy to obtain Pre-TBF and Post-TBF. The TBF change value (ΔTBF) and the change rate (ΔTBF%) before and after induction chemotherapy were calculated. After induction chemotherapy, complete response (CR) and partial response (PR) were classified as response group (RG), and stable disease (SD) as well as progressive disease (PD) were classified as non-response group (NRG). The short-term efficacy was evaluated at 3 months after radiotherapy and divided into CR group and non-CR group (PR, SD and PD). Univariate and multivariate binary logistic regression analysis was used to evaluate the effects of TBF parameters on the response of induction chemotherapy and short-term efficacy. The receiver operating characteristic (ROC) curve was used to evaluate the diagnostic efficacy. Results: Of the 38 patients, 23 (60.5%) were in the RG and 15 (39.5%) in the NRG. There were 22 cases (57.9%) in the CR group and 16 cases (42.1%) in the non-CR group at 3 months after radiotherapy. The CR rate at 3 months after radiotherapy was significantly higher in the RG than that in the NRG (73.9% vs. 33.3%, P=0.02). Pre-TBF was significantly higher than PostTBF in 38 patients (Z＝4.227, P＜0.001). Pre-TBF, ΔTBF and ΔTBF% in the RG were significantly higher than that in the NRG (all P＜0.05); Pre-TBF, ΔTBF, and ΔTBF% were significantly higher in the CR group than that in the non-CR group at 3 months after radiotherapy (all P＜0.05). Multivariate binary logistic regression showed that Pre-TBF was an independent risk factor of the efficacy of induction chemotherapy (P=0.027), with the area under ROC curve (AUC) value of 0.745 (P=0.012). T stage and ΔTBF% were independent risk factors of shortterm efficacy (all P＜0.05), and the AUC value of ΔTBF% was 0.807 (P=0.001). Conclusion: Pre-treatment TBF hyperperfusion in LA-NPC suggests better outcomes. Pre-TBF and ΔTBF% can predict the efficacy of induction chemotherapy and short-term efficacy of LA-NPC, respectively.

       

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