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

Objectives To investigate the prognostic value of diffusion-weighted imaging (DWI) in predicting clinical outcome in patients with cervical cancer after concurrent chemoradiotherapy (CCRT). Methods 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 (Delta ADC(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). Results In multivariate analysis, Delta ADC(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 Delta ADC(mean), the PFS was significantly lower for Delta ADC(mean) < 27.8% (p = 0.001). The CSS and OS were significantly lower for Delta ADC(mean) < 16.1% (p = 0.002 and p < 0.001, respectively). Conclusion The percentage change in tumor ADC may be a useful predictor of disease progression and survival in patients with cervical cancer treated with CCRT.