Yang Chunli,Wu Weili,Jin Feng,et al.A prospective clinical study with long-term follow-up of the correlation between dynamic contrast-enhanced magnetic resonance parameters and prognosis in patients with locally advanced nasopharyngeal carcinoma[J].Chinese Journal of Radiological Medicine and Protection,2020,40(6):446-453
A prospective clinical study with long-term follow-up of the correlation between dynamic contrast-enhanced magnetic resonance parameters and prognosis in patients with locally advanced nasopharyngeal carcinoma
Received:June 18, 2019  
DOI:10.3760/cma.j.issn.0254-5098.2020.06.006
KeyWords:Dynamic contrast-enhanced magnetic resonance imaging  Nasopharyngeal carcinoma  Efficacy evaluation  Prognostic factor
FundProject:贵州省科技计划项目(LG[2012041])
Author NameAffiliationE-mail
Yang Chunli Department of Oncology, Guizhou Cancer Hospital, Affiliated Hospital of Guizhou Medical University, Guiyang 550001, China  
Wu Weili Department of Oncology, Guizhou Cancer Hospital, Affiliated Hospital of Guizhou Medical University, Guiyang 550001, China wwlmhy@163.com 
Jin Feng Department of Oncology, Guizhou Cancer Hospital, Affiliated Hospital of Guizhou Medical University, Guiyang 550001, China  
Li Yuanyuan Department of Oncology, Guizhou Cancer Hospital, Affiliated Hospital of Guizhou Medical University, Guiyang 550001, China  
Long Jinhua Department of Oncology, Guizhou Cancer Hospital, Affiliated Hospital of Guizhou Medical University, Guiyang 550001, China  
Luo Xiuling Department of Oncology, Guizhou Cancer Hospital, Affiliated Hospital of Guizhou Medical University, Guiyang 550001, China  
Chen Yu Department of Oncology, Guizhou Cancer Hospital, Affiliated Hospital of Guizhou Medical University, Guiyang 550001, China  
Tang Hong Department of Oncology, Guizhou Cancer Hospital, Affiliated Hospital of Guizhou Medical University, Guiyang 550001, China  
Zhang Mang Department of Oncology, Guizhou Cancer Hospital, Affiliated Hospital of Guizhou Medical University, Guiyang 550001, China  
Weng Kegui Chongqing Cancer Hospital, Chongqing 400030, China  
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Abstract::
      Objective To explore the relationship between semi-quantitative parameters of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and long-term prognosis of locally advanced nasopharyngeal carcinoma, and to find prognostic indicators from non-invasive images of locally advanced nasopharyngeal carcinoma. Methods Data were collected from January 2011 to January 2012 via a prospective clinical trial with locally advanced nasopharyngeal carcinoma. Clinical information was from 71 patients who completed the treatment plan with long-term follow-ups and UICC 2010 stage Ⅲ, Ⅳ\-A,Ⅳ\-B. The patients received three cycles of Taxotere-Platinol-Fluorouracil (TPF) regimen chrono-chemotherapy, followed by two cycles of concurrent paclitaxel chemotherapy with intensity-modulated radiotherapy (IMRT). DCE-MRI examination was performed before induction chemotherapy to obtain DCE-MRI related semi-quantitative parameters. Correlation analysis was conducted between DCE-MRI related semi-quantitative parameters and short-term efficacy of nasopharyngeal lesions after concurrent radiotherapy and chemotherapy. Results Of all 77 patients, 71 completed treatment and were followed up from 9 to 86 months, with a median follow-up of 77 months, with 80.2% and 67.6% in 3- and 5-year OS, 73.2% and 60.5% in 3- and 5-year PFS, respectively. Evaluation of short-term efficacy of nasopharyngeal lesions after concurrent chemoradiotherapy:the difference in tissue arrival time of contrast agent between complete response (CR) group and partial response (PR) group was statistically significant (t=0.537, P<0.05). Univariate survival analysis found that OS (χ2=3.982,P<0.05) and PFS (χ2=4.019,P<0.05) in the group with short contrast arrival time were significantly higher than those in the group with long contrast arrival time. OS (χ2=7.593,P<0.05) and PFS (χ2=5.624,P<0.05) of patients aged over 45 years were significantly lower than those aged less than 45 years. Cox multivariate regression model showed that advanced clinical stage (stage Ⅳ\-A, Ⅳ\-B) (P=0.048) and age ≥ 45 years (P=0.031) were independent prognostic factors of OS in patients with nasopharyngeal carcinoma. Long arrival time of contrast agent (P=0.018), age ≥ 45 years (P=0.004), advanced N(2-3) stage (P=0.032) and enhancement peak<3 000 (P=0.005) were independent prognostic factors of PFS in patients with nasopharyngeal carcinoma. Conclusions The arrival time of the contrast agent in DCE-MRI may be a reliable prognostic factor for locally advanced nasopharyngeal carcinoma.
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