基于多参数 MRI 的预测模型评估树突状细胞瘤苗治疗胶质母细胞瘤的疗效。
Assessment of treatment response to dendritic cell vaccine in patients with glioblastoma using a multiparametric MRI-based prediction model.
机构信息
Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
出版信息
J Neurooncol. 2023 May;163(1):173-183. doi: 10.1007/s11060-023-04324-4. Epub 2023 May 2.
PURPOSE
Autologous tumor lysate-loaded dendritic cell vaccine (DCVax-L) is a promising treatment modality for glioblastomas. The purpose of this study was to investigate the potential utility of multiparametric MRI-based prediction model in evaluating treatment response in glioblastoma patients treated with DCVax-L.
METHODS
Seventeen glioblastoma patients treated with standard-of-care therapy + DCVax-L were included. When tumor progression (TP) was suspected and repeat surgery was being contemplated, we sought to ascertain the number of cases correctly classified as TP + mixed response or pseudoprogression (PsP) from multiparametric MRI-based prediction model using histopathology/mRANO criteria as ground truth. Multiparametric MRI model consisted of predictive probabilities (PP) of tumor progression computed from diffusion and perfusion MRI-derived parameters. A comparison of overall survival (OS) was performed between patients treated with standard-of-care therapy + DCVax-L and standard-of-care therapy alone (external controls). Additionally, Kaplan-Meier analyses were performed to compare OS between two groups of patients using PsP, Ki-67, and MGMT promoter methylation status as stratification variables.
RESULTS
Multiparametric MRI model correctly predicted TP + mixed response in 72.7% of cases (8/11) and PsP in 83.3% (5/6) with an overall concordance rate of 76.5% with final diagnosis as determined by histopathology/mRANO criteria. There was a significant concordant correlation coefficient between PP values and histopathology/mRANO criteria (r = 0.54; p = 0.026). DCVax-L-treated patients had significantly prolonged OS than those treated with standard-of-care therapy (22.38 ± 12.8 vs. 13.8 ± 9.5 months, p = 0.040). Additionally, glioblastomas with PsP, MGMT promoter methylation status, and Ki-67 values below median had longer OS than their counterparts.
CONCLUSION
Multiparametric MRI-based prediction model can assess treatment response to DCVax-L in patients with glioblastoma.
目的
自体肿瘤裂解物负载树突状细胞疫苗（DCVax-L）是治疗胶质母细胞瘤的一种很有前途的治疗方法。本研究的目的是探讨基于多参数 MRI 的预测模型在评估接受 DCVax-L 治疗的胶质母细胞瘤患者治疗反应中的潜在应用价值。
方法
纳入 17 例接受标准治疗加 DCVax-L 治疗的胶质母细胞瘤患者。当怀疑肿瘤进展（TP）且考虑重复手术时，我们试图根据组织病理学/mRANO 标准确定基于多参数 MRI 的预测模型在区分 TP+混合反应或假性进展（PsP）方面的准确性，将其作为ground truth。多参数 MRI 模型由扩散和灌注 MRI 衍生参数计算得出的肿瘤进展预测概率（PP）组成。比较接受标准治疗加 DCVax-L 治疗与单独接受标准治疗的患者的总生存期（OS）。此外，还进行 Kaplan-Meier 分析，比较使用 PsP、Ki-67 和 MGMT 启动子甲基化状态作为分层变量的两组患者的 OS。
结果
多参数 MRI 模型正确预测 TP+混合反应的病例占 72.7%（8/11），预测 PsP 的病例占 83.3%（5/6），总体一致性率为 76.5%，与组织病理学/mRANO 标准确定的最终诊断一致。PP 值与组织病理学/mRANO 标准之间存在显著的一致性相关系数（r=0.54；p=0.026）。接受 DCVax-L 治疗的患者的 OS 明显长于接受标准治疗的患者（22.38±12.8 与 13.8±9.5 个月，p=0.040）。此外，PsP、MGMT 启动子甲基化状态和 Ki-67 值低于中位数的胶质母细胞瘤患者的 OS 更长。
结论
基于多参数 MRI 的预测模型可评估胶质母细胞瘤患者对 DCVax-L 的治疗反应。
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