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. 2019 Feb;29(2):556-565.
doi: 10.1007/s00330-018-5651-4. Epub 2018 Jul 26.

Prognostic model based on magnetic resonance imaging, whole-tumour apparent diffusion coefficient values and HPV genotyping for stage IB-IV cervical cancer patients following chemoradiotherapy

Gigin Lin  1   2   3   4 , Lan-Yan Yang  3   5 , Yu-Chun Lin  1   2 , Yu-Ting Huang  1   3 , Feng-Yuan Liu  3   6 , Chun-Chieh Wang  2   3   7 , Hsin-Ying Lu  1   2   4 , Hsin-Ju Chiang  1   2   4 , Yu-Ruei Chen  1 , Ren-Chin Wu  3   8 , Koon-Kwan Ng  1   2   3 , Ji-Hong Hong  2   3   7 , Tzu-Chen Yen  3   6 , Chyong-Huey Lai  9   10
Affiliations

Prognostic model based on magnetic resonance imaging, whole-tumour apparent diffusion coefficient values and HPV genotyping for stage IB-IV cervical cancer patients following chemoradiotherapy

Gigin Lin et al. Eur Radiol. 2019 Feb.

Abstract

Objectives: To develop and validate a prognostic model of integrating whole-tumour apparent diffusion coefficient (ADC) from pretreatment diffusion-weighted (DW) magnetic resonance (MR) imaging with human papillomavirus (HPV) genotyping in predicting the overall survival (OS) and disease-free survival (DFS) for women with stage IB-IV cervical cancer following concurrent chemoradiotherapy (CCRT).

Methods: We retrospectively analysed three prospectively collected cohorts comprising 300 patients with stage IB-IV cervical cancer treated with CCRT in 2007-2014 and filtered 134 female patients who underwent MR imaging at 3.0 T for final analysis (age, 24-92 years; median, 54 years). Univariate and multivariate Cox regression analyses were used to evaluate the whole-tumour ADC histogram parameters, HPV genotyping and relevant clinical variables in predicting OS and DFS. The dataset was randomly split into training (n = 88) and testing (n = 46) datasets for construction and independent bootstrap validation of the models.

Results: The median follow-up time for surviving patients was 69 months (range, 9-126 months). Non-squamous cell type, ADC10 <0.77 × 10-3 mm2/s, T3-4, M1 stage and high-risk HPV status were selected to generate a model, in which the OS and DFS for the low, intermediate and high-risk groups were significantly stratified (p < 0.0001). The prognostic model improved the prediction significantly compared with the International Federation of Gynaecology and Obstetrics (FIGO) stage for both the training and independent testing datasets (p < 0.0001).

Conclusions: The prognostic model based on integrated clinical and imaging data could be a useful clinical biomarker to predict OS and DFS in patients with stage IB-IV cervical cancer treated with CCRT.

Key points: • ADC 10 is the best prognostic factor among ADC parameters in cervical cancer treated with CCRT • A novel prognostic model was built based on histology, ADC 10 , T and M stage and HPV status • The prognostic model outperforms FIGO stage in the survival prediction.

Keywords: Cervical cancer; Chemoradiotherapy; Diffusion magnetic resonance imaging; Human papillomavirus; Prognosis.

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