The Prognostic Role of Apparent Diffusion Coefficient Histogram Analysis in Cervical Cancer Patients Treated with Chemoradiotherapy: A Retrospective Study

• Published in: Indian journal of gynecologic oncology 2025-03, Vol.23 (1), Article 16
• Main Authors: Kılıçoğlu, Güçlü Sezai, Akkaş, Ebru Atasever, Gökbayrak Çiledağ, Nazan, Savran, Burcu, Altundağ, Muzaffer Bedri, Kılıç, Abidin Emre, Göksel, Fatih, Karakaya, Ebru
• Format: Article
• Language: English
• Subjects: Medicine; Medicine & Public Health; Oncology; Original Article; Surgical Oncology
• ISSN: 2363-8397; 2363-8400
• DOI: 10.1007/s40944-024-00938-2

Objective This study aimed to investigate the relationship between pretreatment ADC (apparent diffusion coefficient) histogram data and treatment response, disease prognosis, and survival in patients with cervical cancer who underwent definitive chemoradiotherapy (CRT). Materials and Methods We retrospectively analyzed pre-treatment diffusion MRI and clinical data of 54 patients with locally advanced cervical squamous cell carcinoma (SCC) treated with definitive chemoradiotherapy (CRT) between January 2016 and December 2022. ADC values were obtained from ADC maps via whole-lesion histogram analysis. ADC histogram characteristics and related clinical data were correlated with overall survival (OS), progression-free survival (PFS), distant metastasis-free survival (DMFS), and local progression-free survival (LPFS) using univariate and multivariate Cox regression analyses. Results The median age of the 54 patients diagnosed with stage 2a1–4a was 50 years (range 28–76), with a median follow-up of 29.3 months (range 6.7–87.5). During the follow-up, 13 (24.1%) patients died, 15 (27.8%) had distant metastases, 10 (18.5%) experienced local recurrence, and 10 (18.5%) had residual disease. Median OS was not reached; the 5-year OS rate was 63.3%. Median PFS, LPFS, and DMFS were 59.8 months (range 40.4–79.3), 71.8 months (range 39.4–104.2), and 59.8 months (range 40.4–79.3), respectively. Patients with tumor volumes greater than 41.52 cm 3 and/or residual disease had significantly shorter OS, PFS, LPFS, and DMFS. In multivariate analyses, tumor volume at diagnosis and presence of residual disease were significantly associated with all survival outcomes. Additionally, ADC minimum was associated with DMFS and ADC skewness with LPFS. Conclusion In addition to tumor volume and residual disease, ADC minimum and skewness parameters emerged as independent predictive factors for DMFS and LPFS in cervical cancer, as indicated by multivariate analysis results. Clinical Trial Registration The study is not registered in any clinical trial.