表观弥散系数预测局部晚期鼻咽癌对含多西他赛新辅助化疗敏感性的价值

目的:探讨表观弥散系数(ADC)预测局部晚期鼻咽癌对含多西他赛新辅助化疗敏感性的价值.方法:集2013年3月到2015年7月的鼻咽癌III期及IV期患者34例,分别在新辅助化疗前1周内及2周期新辅助化疗结束后1周进行磁共振扫描,采集不同时间点鼻咽癌原发灶的扩散加权图像(DWI)并分析获得的表观扩散系数(ADC),根据RECIST 1.1指南分别进行疗效分组(化疗高反应和化疗低反应组),采用独立样本t检验比较不同疗效组间不同时间点的ADC值,并应用Spearson等级相关性分析评价ADC值与肿瘤消退率的相关性.结果:新辅助化疗前,化疗高反应组的ADC值治疗前低于化疗低反应组[(1.32±0.25)×10-3mm2/s vs (1.61±0.24)×10-3mm2/s,P=0.001];化疗高反应组的ADC值治疗后为(2.12±0.26)×10-3mm2/s,而化疗低反应组的ADC值治疗后为(1.70±0.45)×10-3mm2/s,差异有统计学意义(P=0.032);化疗高反应组ADC值变化率(△ADC)明显高于化疗低反应组[(63.1±35.6)% vs (14.3±36.9)%,P=0.021];ADC值治疗前与肿瘤消退率负相关(r=-0.451,P=0.007),ADC值治疗后和ADC值变化率(△ADC)与肿瘤消退率正相关(r=0.667,P=0.005;r=0.550,P=0.027).结论:核磁共振表观弥散系数对鼻咽癌新辅助化疗疗效可以进行早期评价,有助于早期进行治疗方案的调整.

The value of apparent diffusion coefficient (ADC) for the prediction of neoadjuvant chemotherapy with docetaxel in locally advanced nasopharyngeal carcinoma

Objective:To investigate the capability of apparent diffusion coefficient (ADC) for the prediction of neoadjuvant chemotherapy with docetaxel in locally advanced nasopharyngeal carcinoma.Methods:34 patients with stage Ⅲ-IV nasopharyngeal carcinoma were enrolled,from March 2013 to July 2015.Within 1 week before neoadjuvant chemotherapy and after 2 cycles neoadjuvant chemotherapy about 1 week MRI scan was performed.In different time points nasopharyngeal carcinoma primary diffusion weighted image (DWI) was collected,and the apparent diffusion coefficient (ADC) was analysed.According to RECIST 1.1 guide,patients were divided into chemotherapy high reaction group and chemotherapy low reaction group.Independent sample t-test was to compare different therapeutic groups of ADC values in different time points,and Spearson rank correlation analysis was to evaluate correlation between ADC values and the rate of tumor regression.Results:Before neoadjuvant chemotherapy,chemotherapy high reaction group ADC value was lower than low reaction group[(1.32±0.25)×10-3mm2/s vs (1.61±0.24)×10-3mm2/s,P=0.001].Chemotherapy high reaction group ADC value was (2.12±0.26)×10-3mm2/s after treatment,and chemotherapy low reaction group ADC value after treatment was (1.70±0.45)×10-3mm2/s,which was statistically significant (P=0.032).High chemotherapy response group of ADC value change rate (delta ADC) was significantly higher than low reaction chemotherapy group [(63.1±35.6)% vs (14.3±36.9)%,P=0.021].ADC value before the treatment was negatively related to the tumor regression rate (r=-0.451,P=0.007),and the ADC value after treatment and ADC value change rate (delta ADC) were positively related to the tumor regression rate (r=0.667,P=0.005/r=0.550,P=0.027).Conclusion:Nuclear magnetic resonance apparent diffusion coefficient of nasopharyngeal carcinoma neoadjuvant chemotherapy curative effect can be evaluated early,and help the adjustment of the early treatment.