PDF(Pubmed)
Abstract：
BACKGROUND: The decreased perfusion of osteosarcoma in dynamic contrast-enhanced (DCE) MRI, reflecting a good histological response to neoadjuvant chemotherapy, has been described.
OBJECTIVE: In this study, we aim to explore the potential of the relative wash-in rate as a prognostic factor for event-free survival (EFS).
METHODS: Skeletal high-grade osteosarcoma patients, treated in two tertiary referral centers between 2005 and 2022, were retrospectively included. The relative wash-in rate (rWIR) was determined with DCE-MRI before, after, or during the second cycle of chemotherapy (pre-resection). A previously determined cut-off was used to categorize patients, where rWIR < 2.3 was considered poor and rWIR ≥ 2.3 a good radiological response. EFS was defined as the time from resection to the first event: local recurrence, new metastases, or tumor-related death. EFS was estimated using Kaplan-Meier\'s methodology. Multivariate Cox proportional hazard model was used to estimate the effect of histological response and rWIR on EFS, adjusted for traditional prognostic factors.
RESULTS: Eighty-two patients (median age: 17 years; IQR: 14-28) were included. The median follow-up duration was 11.8 years (95% CI: 11.0-12.7). During follow-up, 33 events occurred. Poor histological response was not significantly associated with EFS (HR: 1.8; 95% CI: 0.9-3.8), whereas a poor radiological response was associated with a worse EFS (HR: 2.4; 95% CI: 1.1-5.0). In a subpopulation without initial metastases, the binary assessment of rWIR approached statistical significance (HR: 2.3; 95% CI: 1.0-5.2), whereas its continuous evaluation demonstrated a significant association between higher rWIR and improved EFS (HR: 0.7; 95% CI: 0.5-0.9), underlining the effect of response to chemotherapy. The 2- and 5-year EFS for patients with a rWIR ≥ 2.3 were 85% and 75% versus 55% and 50% for patients with a rWIR < 2.3.
CONCLUSIONS: The predicted poor chemo response with MRI (rWIR < 2.3) is associated with shorter EFS even when adjusted for known clinical covariates and shows similar results to histological response evaluation. rWIR is a potential tool for future response-based individualized healthcare in osteosarcoma patients before surgical resection.
OBJECTIVE: In this study, we aim to explore the potential of the relative wash-in rate as a prognostic factor for event-free survival (EFS).
METHODS: Skeletal high-grade osteosarcoma patients, treated in two tertiary referral centers between 2005 and 2022, were retrospectively included. The relative wash-in rate (rWIR) was determined with DCE-MRI before, after, or during the second cycle of chemotherapy (pre-resection). A previously determined cut-off was used to categorize patients, where rWIR < 2.3 was considered poor and rWIR ≥ 2.3 a good radiological response. EFS was defined as the time from resection to the first event: local recurrence, new metastases, or tumor-related death. EFS was estimated using Kaplan-Meier\'s methodology. Multivariate Cox proportional hazard model was used to estimate the effect of histological response and rWIR on EFS, adjusted for traditional prognostic factors.
RESULTS: Eighty-two patients (median age: 17 years; IQR: 14-28) were included. The median follow-up duration was 11.8 years (95% CI: 11.0-12.7). During follow-up, 33 events occurred. Poor histological response was not significantly associated with EFS (HR: 1.8; 95% CI: 0.9-3.8), whereas a poor radiological response was associated with a worse EFS (HR: 2.4; 95% CI: 1.1-5.0). In a subpopulation without initial metastases, the binary assessment of rWIR approached statistical significance (HR: 2.3; 95% CI: 1.0-5.2), whereas its continuous evaluation demonstrated a significant association between higher rWIR and improved EFS (HR: 0.7; 95% CI: 0.5-0.9), underlining the effect of response to chemotherapy. The 2- and 5-year EFS for patients with a rWIR ≥ 2.3 were 85% and 75% versus 55% and 50% for patients with a rWIR < 2.3.
CONCLUSIONS: The predicted poor chemo response with MRI (rWIR < 2.3) is associated with shorter EFS even when adjusted for known clinical covariates and shows similar results to histological response evaluation. rWIR is a potential tool for future response-based individualized healthcare in osteosarcoma patients before surgical resection.
摘要：
背景：动态对比增强（DCE）MRI中骨肉瘤的灌注减少，反映了对新辅助化疗的良好组织学反应，已被描述。
目的：在本研究中，我们旨在探讨相对洗入率作为无事件生存期(EFS)预后因素的可能性.
方法：骨骼高级别骨肉瘤患者，在2005年至2022年期间在两个三级转诊中心接受治疗的患者被回顾性纳入.之前用DCE-MRI确定相对洗入率(rWIR)，之后,或在化疗的第二个周期（切除前）。先前确定的截止值用于对患者进行分类，其中rWIR<2.3被认为是差的，rWIR≥2.3是良好的放射学响应。EFS定义为从切除到第一次事件的时间：局部复发，新的转移瘤,或肿瘤相关死亡。EFS是使用Kaplan-Meier的方法进行估计的。多变量Cox比例风险模型用于估计组织学反应和rWIR对EFS的影响，对传统的预后因素进行了调整。
结果：纳入82例患者（中位年龄：17岁；IQR：14-28）。中位随访时间为11.8年（95%CI：11.0-12.7）。随访期间,发生了33个事件不良的组织学反应与EFS没有显着相关（HR：1.8;95％CI：0.9-3.8），而放射学应答差与EFS差相关(HR:2.4;95%CI:1.1-5.0).在没有初始转移的亚群中，rWIR的二元评估接近统计学意义(HR：2.3；95%CI：1.0-5.2)，而其持续评估表明rWIR较高与EFS改善之间存在显著关联(HR:0.7;95%CI:0.5-0.9),强调化疗反应的效果。rWIR≥2.3患者的2年和5年EFS分别为85%和75%，rWIR<2.3患者为55%和50%。
结论：预测的MRI不良化疗反应（rWIR<2.3）与较短的EFS相关，即使对已知的临床协变量进行了调整，并且显示出与组织学反应评估相似的结果。rWIR是骨肉瘤患者手术切除前未来基于反应的个体化医疗的潜在工具。
目的：在本研究中，我们旨在探讨相对洗入率作为无事件生存期(EFS)预后因素的可能性.
方法：骨骼高级别骨肉瘤患者，在2005年至2022年期间在两个三级转诊中心接受治疗的患者被回顾性纳入.之前用DCE-MRI确定相对洗入率(rWIR)，之后,或在化疗的第二个周期（切除前）。先前确定的截止值用于对患者进行分类，其中rWIR<2.3被认为是差的，rWIR≥2.3是良好的放射学响应。EFS定义为从切除到第一次事件的时间：局部复发，新的转移瘤,或肿瘤相关死亡。EFS是使用Kaplan-Meier的方法进行估计的。多变量Cox比例风险模型用于估计组织学反应和rWIR对EFS的影响，对传统的预后因素进行了调整。
结果：纳入82例患者（中位年龄：17岁；IQR：14-28）。中位随访时间为11.8年（95%CI：11.0-12.7）。随访期间,发生了33个事件不良的组织学反应与EFS没有显着相关（HR：1.8;95％CI：0.9-3.8），而放射学应答差与EFS差相关(HR:2.4;95%CI:1.1-5.0).在没有初始转移的亚群中，rWIR的二元评估接近统计学意义(HR：2.3；95%CI：1.0-5.2)，而其持续评估表明rWIR较高与EFS改善之间存在显著关联(HR:0.7;95%CI:0.5-0.9),强调化疗反应的效果。rWIR≥2.3患者的2年和5年EFS分别为85%和75%，rWIR<2.3患者为55%和50%。
结论：预测的MRI不良化疗反应（rWIR<2.3）与较短的EFS相关，即使对已知的临床协变量进行了调整，并且显示出与组织学反应评估相似的结果。rWIR是骨肉瘤患者手术切除前未来基于反应的个体化医疗的潜在工具。
