Prognostic value of ADC quantification for clinical outcome in uterine cervical cancer treated with concurrent...

To investigate the prognostic value of diffusion-weighted imaging (DWI) in predicting clinical outcome in patients with cervical cancer after concurrent chemoradiotherapy (CCRT).

We enrolled 124 cervical cancer patients who received definitive CCRT and underwent 3 T-MRI before and 1 month after initiating treatment. The mean apparent diffusion coefficient (ADC) value was measured on the tumor and the changes in ADC percentage (ΔADC_mean) between the two time points were calculated. The Cox proportion hazard model was used to evaluate the associations between imaging or clinical variables and progression-free survival (PFS), cancer-specific survival (CSS), and overall survival (OS).

In multivariate analysis, ΔADC_mean was the only independent predictor of PFS (hazard ratio [HR] = 0.2379, p = 0.005), CSS (HR = 0.310, p = 0.024), and OS (HR = 0.217, p = 0.002). Squamous cell carcinoma antigen, histology, and pretreatment tumor size were significantly independent predictors of PFS. Tumor size response was significantly independent predictor of CSS and OS. Using the cutoff values of ΔADC_mean, the PFS was significantly lower for ΔADC_mean < 27.8% (p = 0.001). The CSS and OS were significantly lower for ΔADC_mean < 16.1% (p = 0.002 and p < 0.001, respectively).

The percentage change in tumor ADC may be a useful predictor of disease progression and survival in patients with cervical cancer treated with CCRT.

• DWI is widely used as a potential marker of tumor viability. • Percentage change in tumor ADC (ΔADC _mean ) was an independent marker of PFS, CSS, and OS. • Survival was better in patients with ≥ ΔADC _mean cutoff value than with < the cutoff value.