Clinical value of multimodal MRI assessment of the response to apatinib mesylate thera-py in patients with advanced cervical cancer
-
摘要:
目的 探究多模态MRI预测中晚期宫颈癌甲磺酸阿帕替尼治疗反应性的临床价值。 方法 回顾性选取2017年3月~2022年1月于我院住院的60例接受甲磺酸阿帕替尼治疗的中晚期宫颈癌患者作为研究对象，根据患者治疗反应性将其分为A组(存在显著反应，n=48)和B组(无显著反应，n=12)。收集患者一般资料和多模态MRI检查结果，对两组患者治疗前扩散加权成像、T1WI、T2WI和增强T2*加权血管成像序列扫描后图像中肿瘤信号强度进行比较，采用ROC曲线分析多模态MRI对于接受甲磺酸阿帕替尼治疗的中晚期宫颈癌患者治疗反应性的预测效能。 结果 两组患者T1WI序列均以等信号强度为主，T2WI序列均以混杂信号为主，但两组病灶整体信号强度的差异无统计学意义(P > 0.05)。两组患者扩散加权成像序列信号强度均以混杂信号为主，幅度图均以低信号为主，相位图和R2*图均以混杂信号为主，其信号强度之间的差异均具有统计学意义(P < 0.05)。两组患者表观扩散系数(ADC)值、相位值和R2*值的差异有统计学意义(P < 0.05)。ROC曲线显示，ADC值、相位值和R2*值预测宫颈癌患者治疗反应性的曲线下面积分别为0.613、0.656、0.759，R2*值预测效能更高。 结论 接受甲磺酸阿帕替尼治疗的中晚期宫颈癌患者治疗后有无反应性在MR常规序列中的征象具有重叠，无特异性，但有反应性患者在扩散加权成像、T2*加权血管成像图像上表现相对于无反应患者更复杂，ADC值、相位值与R2*值可作为判断阿帕替尼治疗后有无反应的定量指标，其中R2*值的价值更高。 Abstract:Objective To evaluate the clinical value of multimodal MRI assessment of the response to apatinib mesylate therapy in advanced cervical cancer. Methods Sixty inpatients with advanced cervical cancer receiving apatinib mesylate therapy in our hospital from March 2017 to January 2022 were retrospectively enrolled. Patients were assigned into group A (complete response, n=48) and group B (partial response, n=12) according to their treatment response. The general data of patients and multimodal MRI findings were collected. Tumor signal intensity on diffusion-weighted imaging, T1WI, T2WI, and enhanced T2 star-weighted angiography scans were compared. Then ROC curve was plotted to assess the predictive efficacy of multimodal MRI for treatment response of advanced cervical cancer patients to apatinib mesylate therapy. Results The lesions of both groups displayed iso-signal intensity on T1WI sequence, and mixed signal intensity on T2WI sequence, with no statistical difference on the overall signal intensity of the lesions between two groups (P > 0.05). Lesions appeared as mixed signal intensity on diffusion-weighted imaging sequence in both groups. The amplitude map was all dominated by low signals, and the phase and R2* maps were dominated by mixed signals, with statistical difference in the signal intensity (P < 0.05). The apparent diffusion coefficient (ADC), phase value and R2* value demonstrated statistical difference between two groups (P < 0.05). ROC curve analysis denoted that the area under the curve of ADC value, phase value and R2* value in predicting the treatment response to apatinib mesylate therapy were 0.613, 0.656 and 0.759. Conclusion The signs in multimodal MRI of advanced cervical cancer patients with and without response to apatinib mesylate therapy have overlap and are non-specific, but patients with response have more complex performance on diffusion- weighted imaging and enhanced T2 star-weighted angiography images compared with non-response patients. ADC values, phase values and R2* values can be used as quantitative indicators to determine the presence or absence of treatment response after apatinib mesylate therapy, among which R2* value is more valuable. -
图 1 ADC值、相位值和R2*值预测宫颈癌患者治疗反应性的ROC曲线分析
Figure 1. ROC curve analysis of ADC value, phase value, and R2* value predicting treatment response in cervical cancer patients.
表 1 两组患者临床特征资料比较
Table 1. Comparison of clinical characteristics data between two groups of patients
Clinical indicators Group A(n=48) Group B(n=12) t/χ2 P Age (years, Mean±SD) 48.34±6.59 49.17±7.23 0.3829 0.703 BMI(kg/m2, Mean±SD) 26.48±2.13 26.09±2.19 0.5643 0.575 FIGO staging [n(%)] 0.4688 0.494 Phase Ⅲ 33(68.75) 7(58.33) Phase Ⅳ 15(31.25) 5(41.67) Pathological classification [n(%)] 0.4453 0.505 Squamous cell carcinoma 40(83.33) 9(75.00) Adenocarcinoma/adenosquamous carcinoma 8(16.67) 3(25.00) Group A: Complete response group; Group B: Partial response group. 
下载: 导出CSV
表 2 不同治疗反应性宫颈癌患者常规序列扫描病灶整体信号强度
Table 2. Overall signal intensity of lesions in routine sequence scanning of cervical cancer patients with different treatment responsiveness [n(%)]
Conventional MRI sequences T1WI T2WI Group A Group B Group A Group B Hypointense 17(35.42) 2(16.67) 5(10.42) 1(8.33) Slightly hypointense 4(8.33) 1(8.33) 0 0 Isointense 27(56.25) 8(66.67) 0 1(8.33) Slightly hyperintense 0 0 14(29.17) 4(33.33) Hyperintense 0 0 6(12.5) 1(8.33) Mixed 0 1(8.33) 23(47.92) 5(41.67) χ2 5.244 4.320 P 0.155 0.364
下载: 导出CSV
表 3 不同治疗反应性宫颈癌患者DWI序列扫描病灶整体信号强度
Table 3. Overall signal intensity of DWI sequence scanning lesions in patients with different treatment responsive cervical cancer [n(%)]
DWI sequence scan Group A Group B Hypointense 12(25.00) 0 Isointense 14(29.17) 1(8.33) Hyperintense 3(6.25) 2(16.67) Mixed 19(39.58) 9(75.00) χ2 8.497 P 0.037 DWI: Diffusion-weighted imaging.
下载: 导出CSV
表 4 不同治疗反应性宫颈癌患者ESWAN序列扫描病灶整体信号强度
Table 4. Overall signal intensity of ESWAN sequence scanning lesions in patients with different treatment responsive cervical cancer [n(%)]
ESWAN sequence Amplitude map Phase map R2* map Group A Group B Group A Group B Group A Group B Hypointense 37(77.08) 8(66.67) 1(2.08) 2(16.67) 19(39.58) 2(16.67) Isointense 11(22.92) 2(16.67) 17(35.42) 0 6(12.50) 0 Hyperintense 0 0 7(14.58) 0 0 1(8.33) Mixed 0 2(16.67) 23(47.92) 10(83.33) 23(47.92) 9(66.67) χ2 8.312 12.273 8.261 P 0.016 0.007 0.041 ESWAN: Enhanced T2 star-weighted angiography images.
下载: 导出CSV
表 5 ADC值、相位值和R2*值对于宫颈癌患者治疗反应性的预测效能
Table 5. Predictive efficacy of ADC values, phase values and R2* values for treatment responsiveness in cervical cancer patients
Index Cut-off value AUC 95% CI P Sensitivity (%) Specificity (%) ADC value 1.54 0.613 0.457-0.769 0.230 43.8 83.3 Phase value -0.122 0.656 0.457-0.840 0.096 60.4 66.7 R2* value 45.38 0.759 0.613-0.904 0.006 58.3 83.3
下载: 导出CSV
-
[1] 崔芳芳, 鲍俊哲, 王琳琳, 等. 1990-2019年中国女性"两癌"疾病负担变化趋势及预测分析[J]. 中国卫生统计, 2022, 39(5): 647-52. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGWT202205002.htm [2] Small W Jr, Bacon MA, Bajaj A, et al. Cervical cancer: a global health crisis[J]. Cancer, 2017, 123(13): 2404-12. doi: 10.1002/cncr.30667 [3] 李英, 程忠平. 复发性宫颈癌免疫治疗的研究进展[J]. 中国妇产科临床杂志, 2023, 24(1): 108-10. https://www.cnki.com.cn/Article/CJFDTOTAL-FKLC202301041.htm [4] 赖月容, 姜月, 黄欣, 等. 复发/转移宫颈癌患者应用PD-1抑制剂卡瑞利珠单抗联合阿帕替尼治疗的患者报告结局[J]. 中山大学学报: 医学科学版, 2022, 43(4): 591-9. https://www.cnki.com.cn/Article/CJFDTOTAL-ZSYK202204008.htm [5] Yang H, Chen M, Mei ZJ, et al. Effectiveness and prognostic factors of apatinib treatment in patients with recurrent or advanced cervical carcinoma: a retrospective study[J]. Cancer Med, 2021, 10 (13): 4282-90. doi: 10.1002/cam4.3966 [6] Wang M, Perucho JAU, Chan Q, et al. Diffusion kurtosis imaging in the assessment of cervical carcinoma[J]. Acad Radiol, 2020, 27 (5): e94-e101. doi: 10.1016/j.acra.2019.06.022 [7] 王博文, 刘爱连, 赵莹, 等. 增强T2*血管加权成像R2*图纹理分析鉴别肝细胞癌与肝内胆管细胞癌的价值[J]. 中国临床医学影像杂志, 2022, 33(5)339-344 https://www.cnki.com.cn/Article/CJFDTOTAL-LYYX202205008.htm [8] 胡芸, 王翔, 杨帆, 等. MRI多模态成像在炎性乳腺癌早期诊断和新辅助化疗效果评估中的价值[J]. 中华普通外科杂志, 2021, 36(4) 295-300 [9] Salvo G, Odetto D, Pareja R, et al. Revised 2018 International Federation of Gynecology and Obstetrics (FIGO) cervical cancer staging: a review of gaps and questions that remain[J]. Int J Gynecol Cancer, 2020, 30: 873-878. doi: 10.1136/ijgc-2020-001257 [10] 颜文娟, 朱慧婷. 宫颈癌患者根治性手术辅助放化疗后复发的早期死亡影响因素分析[J]. 医学研究生学报, 2021, 34(10): 1073-6. https://www.cnki.com.cn/Article/CJFDTOTAL-JLYB202110012.htm [11] 常建苗, 王静, 刘晓娟. 早期宫颈癌(Ⅰa2~Ⅰb2)复发相关因素分析[J]. 现代妇产科进展, 2021, 30(10): 787-9. https://www.cnki.com.cn/Article/CJFDTOTAL-XDFC202110010.htm [12] 陈卓也, 王新宇. 靶向治疗药物在治疗晚期复发宫颈癌中的研究进展[J]. 现代妇产科进展, 2022, 31(6): 478-80. https://www.cnki.com.cn/Article/CJFDTOTAL-XDFC202206017.htm [13] Zhao LY, Peng YM, He SX, et al. Apatinib induced ferroptosis by lipid peroxidation in gastric cancer[J]. Gastric Cancer, 2021, 24(3): 642-54. doi: 10.1007/s10120-021-01159-8 [14] 洪杨, 刘志铭, 姜洁. 阿帕替尼在妇科恶性肿瘤中的临床研究进展[J]. 实用妇产科杂志, 2021, 37(4): 264-7. https://www.cnki.com.cn/Article/CJFDTOTAL-SFCZ202104010.htm [15] 刘秋利, 李婧, 李娟, 等. 阿帕替尼对宫颈癌细胞增殖及化疗敏感性的影响[J]. 现代妇产科进展, 2017, 26(11): 806-9. https://www.cnki.com.cn/Article/CJFDTOTAL-XDFC201711002.htm [16] 徐洋, 肖华, 姜山山, 等. 阿帕替尼联合放化疗对中晚期宫颈癌患者临床治疗的影响[J]. 中华老年医学杂志, 2021, 40(9): 1165-8. [17] 司福国, 崔佳, 程军, 等. 阿帕替尼致30例不良反应的文献分析[J]. 中国新药杂志, 2020, 29(4): 477-80. https://www.cnki.com.cn/Article/CJFDTOTAL-ZXYZ202004019.htm [18] Kurabayashi T, Ohbayashi N, Sakamoto J, et al. Usefulness of MR imaging for odontogenic tumors[J]. Odontology, 2021, 109(1): 1- 10. [19] 吴青京, 陈昌钊, 李波, 等. 经阴道超声和三维彩色血管能量成像单用及联用对宫颈癌分期的诊断效能研究[J]. 中国超声医学杂志, 2022, 38(1)87-91 https://www.cnki.com.cn/Article/CJFDTOTAL-ZGCY202201023.htm [20] Giovannetti G, Guerrini A, Minozzi S, et al. Computer tomography and magnetic resonance for multimodal imaging of fossils and mummies[J]. Magn Reson Imaging, 2022, 94: 7-17. doi: 10.1016/j.mri.2022.08.019 [21] 刘海涛, 宋天彬, 马杰, 等. 基于扩散加权成像的全域子宫内膜纹理分析对早期子宫内膜恶性病变的诊断价值[J]. 中国医学影像学杂志, 2022, 30(6)593-599 https://www.cnki.com.cn/Article/CJFDTOTAL-ZYYZ202206011.htm [22] 宋伟, 张禹, 张茜, 等. DWI和DCE-MRI定量参数鉴别良恶性软组织肿瘤的价值[J]. 放射学实践, 2022, 37(4): 498-503. https://www.cnki.com.cn/Article/CJFDTOTAL-FSXS202204014.htm [23] 唐竹晓, 徐丽娜, 孙召龙, 等. 磁共振成像动态增强联合DWI序列评估乳腺癌新辅助化疗中肿瘤组织变化应用可行性研究[J]. 中国CT和MRI杂志, 2022, 20(3): 74-6. https://www.cnki.com.cn/Article/CJFDTOTAL-CTMR202203019.htm [24] 李健, 孔德军, 胡祥, 等. 磁共振弥散加权成像表观弥散系数值预测局部晚期宫颈癌腔内后装放射治疗疗效的研究[J]. 中国医学装备, 2023, 20(1)42-46 https://www.cnki.com.cn/Article/CJFDTOTAL-YXZB202301009.htm [25] Ling X, Tang W, Liu G, et al. Assessment of brain maturation in the preterm infants using diffusion tensor imaging (DTI) and enhanced T2 star weighted angiography (ESWAN)[J]. Eur J Radiol, 2013, 82(9): e476-83. doi: 10.1016/j.ejrad.2013.04.003 [26] 杨杰华, 杨忠现, 陈纯娟, 等. DKI及ESWAN技术在评估原发性高血压患者脑实质微结构改变中的应用[J]. 中华神经医学杂志, 2021, 20 (9): 907-14. [27] 程卓, 唐世龙, 周瑜, 等. 定量磁化率成像在孤独症儿童脑铁含量的应用研究[J]. 中国临床医学影像杂志, 2022, 33(2)77-81 https://www.cnki.com.cn/Article/CJFDTOTAL-LYYX202202001.htm [28] 赵博, 曹崑, 李晓婷, 等. MRI动态增强成像参数直方图分析对局部晚期宫颈癌放化疗后的预后评估价值[J]. 中华放射学杂志, 2019, 53 (3)218-223 [29] 王燕鸣, 殷成, 周涛, 等. 增强T2*加权血管成像在宫颈癌诊断及评估放疗疗效的价值[J]. 磁共振成像, 2021, 12(10): 22-25, 31. https://www.cnki.com.cn/Article/CJFDTOTAL-CGZC202110005.htm [30] 田士峰, 刘爱连, 郭妍, 等. 基于增强T2*加权血管成像序列R2*图肿瘤全域纹理分析预测子宫内膜癌微卫星不稳定性[J]. 中国医学影像技术, 2022, 38(2): 257-61. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYXX202202020.htm -
点击查看大图
图(1) / 表(5)
计量
- 文章访问数: 67
- HTML全文浏览量: 55
- PDF下载量: 3
- 被引次数: 0
