Application Of MRI In Predicting The Prognosis Of Neoadjuvant Therapy And Concurrent Chemoradiotherapy In Stage Ⅰ B2 And Ⅱ A2 Cervical Cancer

Objective: To investigate the effect of neoadjuvant therapy combined with surgery and concurrent chemoradiotherapy(CCRT)on the prognosis of patients with stage IB2 and IIA2 cervical cancer,and the predictive value of MRI-DWI(diffusion weighted imaging)in predicting the recurrence of patients with stage IB2 and IIA2 cervical cancer after treatment.Methods: Retrospectively enrolled 170 patients with stage IB2 and IIA2 cervical cancer who received neoadjuvant therapy or concurrent chemoradiotherapy in our hospital from February 2015 to October 2018.100 patients in the neoadjuvant(NT)group and70 patients in the CCRT group.The patient was confirmed by pathology as squamous cell carcinoma,adenocarcinoma or adenosquamous carcinoma.Conventional MRI and DWI were performed before treatment.The clinical indicators of patients like pre-treatment squamous cell antigen(SCC-Ag)and hemoglobin(Hb)and postoperative pathological factors of neoadjuvant patients(lymph node metastasis,deep stromal invasion and vascular invasion)were collected.Two radiologists measured the maximum diameter of tumor(MDT)and apparent diffusion coefficient(ADC)on MRI images.The local recurrence,metastasis(local or distant metastasis)and death were recorded by regular follow-up,and the disease-free survival(DFS)was calculated.The side effects of NT group and CCRT group were recorded.The intraclass correlation coefficient(ICC)was used to assess the consistency between between two radiologists.Independent sample t-test,Mann-Whitney test and chi-square test were used to compare the differences of clinical indexes,pathological factors and imaging indexes between with recurrent patients and non-recurrent patients.Logistic regression was employed to established combined prediction model of clinical,pathological and imaging indexes.The receiver operating characteristic curve was used to analyze the diagnostic performance of sole indexes and combined prediction model.Delong test was used to analyze the difference of the area under the curve(AUC)between the sole indexes and the combined model.Kaplan-Meier method and Cox proportional hazard model analysis were used to correlate all variables with DFS.Results:1.Among the 170 patients,26 cases suffered recurrence and metastases,including 15 cases in NT group and 11 cases in CCRT group.2.The ICC of MDT and the primary tumor ADC values measured by the two radiologists were ranged from 0.772 to 0.877,which were all highly consistent.3.There were no significant differences in clinical and imaging indexes between NT group and CCRT group(all P>0.05).4.In the entire cohort,there was a significant difference in SCC-Ag between recurrent and non-recurrent patients(P=0.042).There were significant differences in SCC-Ag,lymph nodes metastasis,vascular invasion and deep stromal invasion between recurrent and non-recurrent patients in NT group(all P<0.05).There were no differences in clinical and pathological indexes between recurrent and non-recurrent patients in CCRT group(all P>0.05).In the entire cohort,there were significant differences in pelvic lymph nodes metastases,tumor ADCmax and ADCmin between recurrent and non-recurrent patients(all P=0.001).The difference in tumor ADCmin between recurrent and non-recurrent patients in NT group was statistically significant(P=0.004).The differences in tumor size,lymph nodes metastases,tumor ADCmax and ADCmin between recurrent and non-recurrent patients in CCRT group were statistically significant.(all P<0.05).5.In the entire cohort,tumor ADCmin had the highest AUC of 0.722,with a sensitivity of 84.00%,and specificity of 57.70%.AUC of the combined prediction model was0.977,the sensitivity and specificity were 92.30%,and 95.80%,respectively.The AUC of combining model was significantly higher than that of ADCmin(P<0.05).6.170 patients were followed up for more than two years,and the median follow-up was 41.77 months(3.15-71.47 months).The 2-year DFS rate of neoadjuvant patients was 87%,and the 2-year DFS rate of CCRT patients was 85%.There was no significant difference in 2-year DFS rate between the two groups(P=0.701).7.Univariate and multivariate analysis showed that ADCmax,ADCmin and SCC-Ag were independent risk factors for prognosis in all patients.ADCmin,SCC-Ag and vascular invasion in NT group were independent risk factors affecting the DFS of patients.ADCmax,ADCmin and MDT were independent risk factors for prognosis of patients in CCRT group.8.The differences in hematologic reaction and gastrointestinal reaction between patients in NT group and CCRT group were statistically significant(all P<0.05).There was no significant difference in cystitis between patients in NT group and CCRT group.Conclusion:1.The effects between neoadjuvant therapy combined with radical surgery and CCRT on the prognosis of patients with stage IB2 and IIA2 cervical cancer were close.Pretreatment SCC-Ag,vascular invasion and deep stromal invasion influenced the prognosis of patients.2.MRI-DWI had potential value in predicting the prognosis of patients with IB2 and IIA2 disease.The ADC values of primary tumor were helpful to predict the recurrence of patients with IB2 and IIA2 disease post treatment.ADCmin had a greater effect on the prognosis of neoadjuvant therapy patients,and ADCmax had a greater impact on the prognosis of CCRT patients.3.Neoadjuvant therapy combined with surgery had a similar survival to CCRT but with less side effects,which suggested that could be a potential beneficial alternative treatment.A larger randomized trial is required to confirm these results.