| Objective: The aim was to further verify the value of ADC value,tumor volume,serum alkaline phosphatase,lactate dehydrogenase and their rates of change before and after neoadjuvant chemotherapy to monitor the efficacy of neoadjuvant chemotherapy in osteosarcoma.In addition,we want to get the value of the above parameters to monitor the efficacy of chemotherapy early at the first phase of neoadjuvant chemotherapy.Methods: The clinical and imaging data of 38 patients with osteosarcoma were prospectively collected in this study.After removing 7cases that did not fit the criteria,31 cases did the statistical analysis.The patients were divided into two groups according to histological necrosis rates after operation: A good response group was defined as necrosis rates>90%,and a poor response group as necrosis rates≤90%.MR examinations were performed before neoadjuvant chemotherapy(MR1),5 days after the first phase of neoadjuvant chemotherapy(MR2),and after the end of the entire phase of chemotherapy(MR3).Conventional T1 WI,PDWI-FS and DWI sequences were performed.The maximum vertical diameter,anteroposterior diameter,and lateral diameter of the tumor were measured on conventional MR sequences,and the tumor volume was calculated based on the oval tumor volume formula V=π/6×(anteroposterior diameter × lateral diameter ×vertical diameter).The average ADC values of the intraosseous component,the soft tissue mass component,and the whole tumor cross-sectional were measured on the transverse axis at the maximum cross-sectional area of the tumor.The values of serum alkaline phosphatase(ALP)and lactate dehydrogenase(LDH)were collected before chemotherapy,after first phase chemotherapy,and before surgery.The tumor volumes were recorded as V1 before chemotherapy,V2 after first phase of chemotherapy,and V3 beforesurgery respectively.The volume change rates before and after first phase of chemotherapy was ΔV2-1=(V2-V1)/ V1.The volume change rates before and after the last phase chemotherapy was ΔV3-1=(V3-V1)/ V1.The notation and calculation method of ADC,ALP,LDH and their change rates are the same as that of the volume.SPSS 21.0 statistical software was used for statistical analysis of data.The ADC values,the volumes,the ALP and LDH values and their change rates are compared between the “good responder” and the “poor responder”groups.If the data is gaussian distributed and the variance is equal,it will take two independent sample t-tests;otherwise,it will use Mann-Whitney nonparametric tests.ROC curve analysis was performed on data with statistical significance.For all tests,P<0.05 was as significant.In addition,Spearman statistical analysis was used to test the correlation between ADC change rates,volume change rates,change rates of ALP as well as the LDH and histological necrosis rates.Result: A total of 31 patients were included,of which 8 were in the good response group and 23 in the poor response group.The ALP and LDH values were only collected in 25 cases,including 8 in the good response group and 17 in the poor response group.1 ADCThere was a statistically significant difference between the two groups in average ADC values of whole tumor section(P=0.048).The mean value of ADCwhole3 in the good response group was 1.492±0.281×10-3mm2/s,and the mean value of ADC in the poor response group was 1.223±0.368×10-3mm2/s;ADC1,ADC2,ADCsoft3,ADCbone3 had no statistical difference between the two groups.The ROC curve analysis showed that the sensitivity of predicting good chemotherapy response was 75% when ADCwhole3≥1.370 × 10-3mm2/s,the specificity was 65.2%,and that the area under the curve was 0.728.The ΔADCsoft2-1 had statistically significant difference between the two groups(P=0.007).The mean value of ΔADCsoft2-1 in good response group was 0.117±0.085,and the mean value of ΔADCsoft2-1 in poor response groupwas-0.023 ± 0.181;the ROC curve analysis showed that the sensitivity to predict good chemotherapy response was 75% whenΔADCsoft2-1≥0.0685,the specificity was 78.3%,and the area under the curve was 0.774.ΔADCwhole2-1had a significant difference between the two groups(P=0.038).The mean value of ΔADCwhole2-1 in good response group was 0.134±0.097,and the mean value of ΔADCwhole2-1 in poor response group was 0.024±0.171.5;the ROC curve analysis showed that the sensitivity to predict good chemotherapy response was 87.5% whenΔADCwhole2-1≥0.0490,the specificity was 60.9%,and the area under the curve was 0.723.Δ ADCwhole3-1 was significantly different between the two groups(P=0.028).The mean value of ΔADCwhole3-1in good response group was 0.220 ± 0.183,and the mean value of ΔADCwhole3-1 in poor response group was-1 0.018 ± 0.257;the ROC curve analysis showed that the sensitivity to predict good chemotherapy response was 87.5% whenΔADCwhole3-1≥0.0940,specificity was 69.6%,and the area under the curve was 0.777.2 volumeThe results showed that the median was 372.572 cm3 in the good response group,and the median was 215.750cm3 in the poor response group before chemotherapy.The volume of the good response group was greater than that of the poor response group.The difference between the two groups was statistically significant(P=0.030).There was no significant difference in V2 and V3 between the two groups.The results showed that: ΔV2-1 of good response group was-0.055±0.193,and ΔV2-1 of poor response group was 0.275±0.298,and there was a significant difference in ΔV2-1 between the two groups(P=0.002);the ROC curve analysis showed that the sensitivity to predict poor chemotherapy response was 73.9% when ΔV2-1≥0.0905,specificity was 87.5%,and the area under the curve was 0.837.ΔV3-1 of good response group was-0.187±0.422,and Δ V3-1 of poor response group was 0.245 ± 0.556,and there was a significant difference in ΔV3-1 between the two groups(P=0.036);the ROC curve analysis showed that the sensitivity to predicting poor response was60.9% when ΔV3-1≥0.0090,the specificity was 87.5%,and the area under the curve was 0.728.3 ALP and LDHThere was no significant difference in ALP1,ALP2,ALP3,LDH1,LDH2 and LDH3 between the two groups.ΔALP3-1 of good response group was-0.544±0.208,and ΔALP3-1 of poor response group was-0.213±0.304,and there was a significant difference in Δ ALP3-1 between the two groups(P=0.005);the ROC curve analysis showed that the sensitivity to predict poor response was 88.2% when ΔALP3-1≥-0.4323,the specificity was 75%,and the area under the curve was0.824.There was no significant difference in ΔALP2-1,ΔLDH2-1 and ΔLDH3-1 between the two groups.4 There was no correlation among the change rates of ADC,volume,ALP as well as the LDH and histological necrosis rates.Conclusion:1 The change rates of ADC values before and after the first phase of neoadjuvant chemotherapy for osteosarcoma can monitor the efficacy of chemotherapy early.2 The change rates of mean ADC values of the whole tumor section before and after neoadjuvant chemotherapy was the most reliable parameter for monitoring the response to chemotherapy,and it can provide support for limb salvage surgery.3 The increase of tumor volume after neoadjuvant chemotherapy of osteosarcoma predicted poor response.It can help clinicians to determine whether to change chemotherapy regimens or to perform surgery early.4 The change rates of ALP before and after neoadjuvant chemotherapy of osteosarcoma can be used as a predictor of poor response,but it cannot predicte response at an early stage.5 The value of LDH and its change rates before and after neoadjuvant chemotherapy of osteosarcoma cannot monitor the chemotherapy response. |
PDF Full Text Request