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

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。

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 Post-TBF in 38 patients(Z=4.227,P<0.001).Pre-TBF,ΔTBF andΔTBF%in the RG were significantly higher than that in the NRG(all P<0.05);Pre-TBF,ΔTBF,andΔTBF%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 andΔTBF%were independent risk factors of shortterm efficacy(all P<0.05),and the AUC value ofΔTBF%was 0.807(P=0.001).Conclusion:Pre-treatment TBF hyperperfusion in LA-NPC suggests better outcomes.Pre-TBF andΔTBF%can predict the efficacy of induction chemotherapy and short-term efficacy of LA-NPC,respectively.