Apparent diffusion coefficient histogram analysis stratifies progression-free and overall survival in patients with recurrent GBM treated with bevacizumab: A multi-center study

Whitney B. Pope, Xin Joe Qiao, Hyun J. Kim, Albert Lai, Phioanh Nghiemphu, Xi Xue, Benjamin M. Ellingson, David Schiff, Dawit Aregawi, Soonmee Cha, Vinay K. Puduvalli, Jing Wu, Wai Kwan A. Yung, Geoffrey S. Young, James Vredenburgh, Dan Barboriak, Lauren E. Abrey, Tom Mikkelsen, Rajan Jain, Nina A. PaleologosPatricia Lada Rn, Michael Prados, Jonathan Goldin, Patrick Y. Wen, Timothy Cloughesy

Research output: Contribution to journalArticlepeer-review

115 Scopus citations

Abstract

We have tested the predictive value of apparent diffusion coefficient (ADC) histogram analysis in stratifying progression-free survival (PFS) and overall survival (OS) in bevacizumab-treated patients with recurrent glioblastoma multiforme (GBM) from the multi-center BRAIN study. Available MRI's from patients enrolled in the BRAIN study (n = 97) were examined by generating ADC histograms from areas of enhancing tumor on T1 weighted post-contrast images fitted to a two normal distribution mixture curve. ADC classifiers including the mean ADC from the lower curve (ADC-L) and the mean lower curve proportion (LCP) were tested for their ability to stratify PFS and OS by using Cox proportional hazard ratios and the Kaplan-Meier method with log-rank test. Mean ADC-L was 1,209 9 10-6mm2/s ± 224 (SD), and mean LCP was 0.71 ± 0.23 (SD). Low ADC-L was associated with worse outcome. The hazard ratios for 6-month PFS, overall PFS, and OS in patients with less versus greater than mean ADC-L were 3.1 (95 % confidence interval: 1.6, 6.1; P = 0.001), 2.3 (95 % CI: 1.3, 4.0; P = 0.002), and 2.4 (95 % CI: 1.4, 4.2; P = 0.002), respectively. In patients with ADC-L\1,209 and LCP[0.71 versus ADC-L[1,209 and LCP \0.71, there was a 2.28-fold reduction in the median time to progression, and a 1.42-fold decrease in the median OS. The predictive value of ADC histogram analysis, in which low ADC-L was associated with poor outcome, was confirmed in bevacizumab-treated patients with recurrent GBM in a post hoc analysis from the multicenter (BRAIN) study.

Original languageEnglish (US)
Pages (from-to)491-498
Number of pages8
JournalJournal of neuro-oncology
Volume108
Issue number3
DOIs
StatePublished - Jul 2012

All Science Journal Classification (ASJC) codes

  • Oncology
  • Neurology
  • Clinical Neurology
  • Cancer Research

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