Strain elastography as an early predictor of long-term prognosis in patients with locally advanced cervical cancers treated with concurrent chemoradiotherapy
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To explore the value of strain elastography as an early predictor of long-term prognosis in patients with locally advanced cervical cancers treated with concurrent chemoradiotherapy (CCRT).
Strain elastography examinations were performed on 45 patients with locally advanced cervical cancers at 3 time points: prior to CCRT, and at 1 and 2 weeks after the start of CCRT. The maximum tumor diameter (Dmax), strain ratio (SR), and their percentage changes (ΔDmax and ΔSR) were calculated to predict long-term prognosis. Based on the results of physical examinations, Papanicolaou test, and pelvic magnetic resonance imaging, we classified patients into two groups: responders (complete remission) and non-responders (sustained disease, recurrence, or death).
After a median follow-up of 30 months (range, 12–36 months), 36 of 45 (80%) patients were disease free. The Dmax as well as ΔDmax at 2 weeks during CCRT was able to predict the responder outcomes, with an area-under-the-curve (AUC) of 0.733 and 0.731, respectively. Furthermore, significant differences in SR and ΔSR at 1 and 2 weeks during therapy were shown between the responder and non-responder groups (all p < 0.05), and ΔSR at 2 weeks during CCRT presented with the highest AUC (0.91), yielding 88.9% sensitivity and 88.9% specificity with a selected cutoff value.
Strain elastography may be useful as an early predictor of long-term outcomes after CCRT for patients with cervical cancer.
• The D max as well as ΔD max at 2 weeks during CCRT can predict the responder outcomes.
• The elastography parameters (SR and ΔSR) exhibited predictive values of favorable response after therapy initiation.
• ΔSR at 2 weeks during CCRT held the best predictive value for the responder outcomes.
KeywordsElastography Treatment outcome Cervical cancer Concurrent chemoradiotherapy
Maximum long axis diameter
External beam radiotherapy
International federation of gynecology and obstetrics
High dose rate
Intraclass correlation coefficient
Magnetic resonance imaging
- Post T1
At 1 week during therapy
- Post T2
At 2 weeks during therapy
- Pre Tx
Prior to therapy
This study has received funding from the National Natural Science Foundation of China (ID: 81501441, 81671751), Social Development Foundation of Jiangsu Province (BE2015605), the Natural Science Foundation of Jiangsu Province (ID: BK20131281,BK20150109, BK20150102), Jiangsu Province Health and Family Planning Commission Youth Scientific Research Project (ID: Q201508), and Six Talent Peaks Project of Jiangsu Province (ID: 2015-WSN-079).
Compliance with ethical standards
The scientific guarantor of this publication is Zhengyang Zhou.
Conflict of interest
The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.
Statistics and biometry
No complex statistical methods were necessary for this paper.
Written informed consent was obtained from all subjects (patients) in this study.
Institutional Review Board approval was obtained.
• diagnostic or prognostic study
• performed at one institution
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