文章：

表观扩散系数作为前列腺癌患者接受雄激素剥夺疗法与放疗治疗局部及总体反应早期预测因素

Apparent Diffusion Coefficient as an Early Predictive Factor of Local and Overall Response to Treatment with Androgen Deprivation Therapy and Radiotherapy in Patients with Prostate Cancer

原文发布日期：24 February 2025

DOI: 10.3390/cancers17050762

类型: Article

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英文摘要：

Background/Objectives: To analyze the predictive value of the apparent diffusion coefficient (ADC) in patients with prostate cancer (PCa) treated with radiotherapy (RT) and androgen deprivation therapy (ADT).Methods: Retrospective study of patients with high-risk, very high-risk, or unfavorable intermediate-risk PCa who received RT and ADT between 2008 and 2019 and underwent multiparametric magnetic resonance imaging mpMRI) at 6 months post-RT. Differences in ADC values were compared between patients with and without progression and/or local recurrence. Receiver operating characteristic (ROC) curves were used to obtain ADC cutoffs for predicting 10-year progression-free-survival (PFS) and local recurrence-free survival (LRFS).Results: We evaluated 98 patients (73 [74.5%] high-risk). Over a mean ± SD follow-up of 95.36 ± 30.54 months, 19 patients (19.4%) progressed; at 10 years, PFS was 75.6%, LRFS 93.8%, metastasis-free survival 85.5%, and overall survival 89.5%. Post-RT ADC was significantly lower in patients with local recurrence (1.09 ± 0.18 vs. 1.30 ± 0.20 × 10−3mm2/s,p= 0.020) and progression (1.23 ± 0.20 vs. 1.30 ± 0.21 × 10−3mm2/s,p= 0.004). ROC analysis identified a post-RT ADC cutoff of 1.11 × 10−3mm2/s for local recurrence (area under curve [AUC] 0.843, sensitivity 89.4%, positive predictive value [PPV] 98.8%). The cutoff for progression was 1.24 × 10−3mm2/s (AUC0.705, sensitivity 72.2%, PPV87.7%). Patients with a post-RT ADC value below and above 1.11 × 10−3mm2/shad a 10-year LRFS of 66.8% and 97.7%, respectively (HR: 25.04 [2.58–242.92],p< 0.001). The corresponding rates for 10-year PFS were 58.6% and 85.6% in patients with post-RT ADC values below and above 1.24 × 10−3mm2/s (HR: 2.916 [1.113–7.644],p= 0.015). In the multivariate analysis, a post-treatment ADC value ≤ 1.24 × 10−3mm2/s was a significant prognostic factor for a lower PFS (HR: 3823 [1371–10,657],p= 0.010).Conclusions: This is the first study to show that post-RT ADC can be a predictive factor of local recurrence in PCa treated with RT and ADT. Moreover, this long-term study demonstrates its value as a predictive factor of progression in PCa treated with RT and ADT.

摘要翻译： 

背景/目的：分析表观扩散系数（ADC）在接受放疗（RT）和雄激素剥夺疗法（ADT）治疗的前列腺癌（PCa）患者中的预测价值。 方法：回顾性研究2008年至2019年间接受RT和ADT治疗的高危、极高危或不良中危PCa患者，并在RT后6个月接受多参数磁共振成像（mpMRI）。比较有进展和/或局部复发患者与无进展患者的ADC值差异。采用受试者工作特征（ROC）曲线获取预测10年无进展生存期（PFS）和局部无复发生存期（LRFS）的ADC截断值。 结果：共评估98例患者（其中73例[74.5%]为高危）。平均随访95.36 ± 30.54个月期间，19例患者（19.4%）出现进展；10年PFS为75.6%，LRFS为93.8%，无转移生存率为85.5%，总生存率为89.5%。局部复发患者的RT后ADC值显著更低（1.09 ± 0.18 vs. 1.30 ± 0.20 × 10⁻³mm²/s，p=0.020），进展患者亦显著更低（1.23 ± 0.20 vs. 1.30 ± 0.21 × 10⁻³mm²/s，p=0.004）。ROC分析确定RT后ADC截断值1.11 × 10⁻³mm²/s可预测局部复发（曲线下面积[AUC] 0.843，敏感性89.4%，阳性预测值[PPV] 98.8%），进展的截断值为1.24 × 10⁻³mm²/s（AUC 0.705，敏感性72.2%，PPV 87.7%）。RT后ADC值低于和高于1.11 × 10⁻³mm²/s的患者10年LRFS分别为66.8%和97.7%（HR：25.04 [2.58–242.92]，p<0.001）；RT后ADC值低于和高于1.24 × 10⁻³mm²/s的患者10年PFS分别为58.6%和85.6%（HR：2.916 [1.113–7.644]，p=0.015）。多变量分析显示，治疗后ADC值≤1.24 × 10⁻³mm²/s是较低PFS的显著预后因素（HR：3823 [1371–10,657]，p=0.010）。 结论：本研究首次证明RT后ADC可作为RT联合ADT治疗的PCa患者局部复发的预测因素。此外，这项长期研究证实了其作为RT联合ADT治疗的PCa进展预测因素的价值。

原文链接：

Apparent Diffusion Coefficient as an Early Predictive Factor of Local and Overall Response to Treatment with Androgen Deprivation Therapy and Radiotherapy in Patients with Prostate Cancer