Does the application of diffusion weighted imaging improve the prediction of survival in patients with resected brain metastases? A retrospective multicenter study
Tóm tắt
Brain metastases are common in clinical practice. Many clinical scales exist for predicting survival and hence deciding on best treatment but none are individualised and none use quantitative imaging parameters. A multicenter study was carried out to evaluate the prognostic utility of a simple diffusion weighted MRI parameter, tumor apparent diffusion coefficient (ADC). A retrospective analysis of imaging and clinical data was performed on a cohort of 223 adult patients over a ten-year period 2002–2012 pooled from three institutions. All patients underwent surgical resection with histologically confirmed brain metastases and received adjuvant whole brain radiotherapy and/or chemotherapy. Survival was modelled using standard clinical variables and statistically compared with and without the addition of tumor ADC. The median overall survival was 9.6 months (95% CI 7.5–11.7) for this cohort. Greater age (p = 0.002), worse performance status (p < 0.0001) and uncontrolled extracranial disease (p < 0.0001) were all significantly associated with shorter survival in univariate analysis. Adjuvant whole brain radiotherapy (p = 0.007) and higher tumor ADC (p < 0.001) were associated with prolonged survival. Combining values of tumor ADC with conventional clinical scoring systems such as the Graded Prognostic Assessment (GPA) score significantly improved the modelling of survival (e.g. concordance increased from 0.5956 to 0.6277 with Akaike’s Information Criterion reduced from 1335 to 1324). Combining advanced MRI readings such as tumor ADC with clinical scoring systems is a potentially simple method for improving and individualising the estimation of survival in patients having surgery for brain metastases.
Tài liệu tham khảo
Nayak L, Lee EQ, Wen PY. Epidemiology of brain metastases. Curr Oncol Rep. 2012;14:48–54.
Gaspar L, Scott C, Rotman M, et al. Recursive partitioning analysis (RPA) of prognostic factors in three radiation therapy oncology group (RTOG) brain metastases trials. Int J Radiat Oncol Biol Phys. 1997;37:745–51.
Sperduto PW, Berkey B, Gaspar LE, et al. A new prognostic index and comparison to three other indices for patients with brain metastases: an analysis of 1,960 patients in the RTOG database. Int J Radiat Oncol Biol Phys. 2008;70:510–4.
Sperduto PW, Chao ST, Sneed PK, et al. Diagnosis-specific prognostic factors, indexes, and treatment outcomes for patients with newly diagnosed brain metastases: a multi-institutional analysis of 4,259 patients. Int J Radiat Oncol Biol Phys. 2010;77:655–61.
Berghoff AS, Wolpert F, Holland-Letz T, et al. Combining standard clinical blood values for improving survival prediction in patients with newly diagnosed brain metastases-development and validation of the LabBM score. Neuro-Oncology. 2017;19(9):1255–62.
Sperduto PW, Jiang W, Brown PD, et al. Estimating Survival in Melanoma Patients With Brain Metastases: An Update of the Graded Prognostic Assessment for Melanoma Using Molecular Markers (Melanoma-molGPA). Int J Radiat Oncol Biol Phys. 2017;99:812–6.
Sperduto PW, Kased N, Roberge D, et al. Effect of tumor subtype on survival and the graded prognostic assessment for patients with breast cancer and brain metastases. Int J Radiat Oncol Biol Phys. 2012;82:2111–7.
Sperduto PW, Yang TJ, Beal K, et al. Estimating survival in patients with lung Cancer and brain metastases: an update of the graded prognostic assessment for lung Cancer using molecular markers (lung-molGPA). JAMA Oncol. 2017;3:827–31.
Zakaria R, Das K, Bhojak M, et al. The role of magnetic resonance imaging in the management of brain metastases: diagnosis to prognosis. Cancer Imaging. 2014;14:8.
Berghoff AS, Spanberger T, Ilhan-Mutlu A, et al. Preoperative diffusion-weighted imaging of single brain metastases correlates with patient survival times. PLoS One. 2013;8:e55464.
Lee CC, Wintermark M, Xu Z, et al. Application of diffusion-weighted magnetic resonance imaging to predict the intracranial metastatic tumor response to gamma knife radiosurgery. J Neuro-Oncol. 2014;118:351–61.
Zakaria R, Das K, Radon M, et al. Diffusion-weighted MRI characteristics of the cerebral metastasis to brain boundary predicts patient outcomes. BMC Med Imaging. 2014;14:26.
Zakaria R, Das K, Bhojak M, et al. The reliability of routine clinical post-processing software in assessing potential diffusion-weighted MRI “biomarkers” in brain metastases. Magn Reson Imaging. 2014;32:291–6.
Akaike H. A new look at the statistical model identification. IEEE Trans Autom Control. 1974;19:716–23.
Duygulu G, Ovali GY, Calli C, et al. Intracerebral metastasis showing restricted diffusion: correlation with histopathologic findings. Eur J Radiol. 2010;74:117–20.
Hayashida Y, Hirai T, Morishita S, et al. Diffusion-weighted imaging of metastatic brain tumors: comparison with histologic type and tumor cellularity. AJNR Am J Neuroradiol. 2006;27:1419–25.
Owonikoko TK, Arbiser J, Zelnak A, et al. Current approaches to the treatment of metastatic brain tumours. Nat Rev Clin Oncol. 2014;11:203–22.
Serres S, Martin CJ, Sarmiento Soto M, et al. Structural and functional effects of metastases in rat brain determined by multimodal MRI. Int J Cancer. 2014;134:885–96.
Sasaki M, Yamada K, Watanabe Y, et al. Variability in absolute apparent diffusion coefficient values across different platforms may be substantial: a multivendor, multi-institutional comparison study. Radiology. 2008;249:624–30.
Grech-Sollars M, Hales PW, Miyazaki K, et al. Multi-Centre reproducibility of diffusion MRI parameters for clinical sequences in the brain. NMR Biomed. 2015;28:468–85.
Tofts PS, Collins DJ (2011) Multicentre imaging measurements for oncology and in the brain. Br J Radiol 84 Spec No 2:S213-S226.
Padhani AR, Liu G, Koh DM, et al. Diffusion-weighted magnetic resonance imaging as a cancer biomarker: consensus and recommendations. Neoplasia. 2009;11:102–25.
Bhatia A, Birger M, Veeraraghavan H, et al. MRI radiomic features are associated with survival in melanoma brain metastases treated with immune checkpoint inhibitors. Neuro-Oncology. 2019;21:1578–86.