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Research ArticleHead and Neck Imaging

Pretreatment DWI with Histogram Analysis of the ADC in Predicting the Outcome of Advanced Oropharyngeal Cancer with Known Human Papillomavirus Status Treated with Chemoradiation

M. Ravanelli, A. Grammatica, M. Maddalo, M. Ramanzin, G.M. Agazzi, E. Tononcelli, S. Battocchio, P. Bossi, M. Vezzoli, R. Maroldi and D. Farina
American Journal of Neuroradiology July 2020, DOI: https://doi.org/10.3174/ajnr.A6695
M. Ravanelli
aFrom the Departments of Radiology (M. Ravanelli, M. Ramanzin, G.M.A., E.T., R.M., D.F.)
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A. Grammatica
bOtorhinolaryngology (A.G.)
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M. Maddalo
cRadiation Oncology (M.M.)
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M. Ramanzin
aFrom the Departments of Radiology (M. Ravanelli, M. Ramanzin, G.M.A., E.T., R.M., D.F.)
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G.M. Agazzi
aFrom the Departments of Radiology (M. Ravanelli, M. Ramanzin, G.M.A., E.T., R.M., D.F.)
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  • ORCID record for G.M. Agazzi
E. Tononcelli
aFrom the Departments of Radiology (M. Ravanelli, M. Ramanzin, G.M.A., E.T., R.M., D.F.)
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S. Battocchio
dPathological Anatomy (S.B.)
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P. Bossi
eMedical Oncology (P.B.)
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M. Vezzoli
fMolecular and Translational Medicine (M.V.), University of Brescia, Brescia, Italy.
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R. Maroldi
aFrom the Departments of Radiology (M. Ravanelli, M. Ramanzin, G.M.A., E.T., R.M., D.F.)
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D. Farina
aFrom the Departments of Radiology (M. Ravanelli, M. Ramanzin, G.M.A., E.T., R.M., D.F.)
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Article Figures & Data

Figures

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  • FIG 1.
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    FIG 1.

    Axial T2, b = 1000, and ADC map of an OPSCC of the right palatine tonsil.

  • FIG 2.
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    FIG 2.

    Kaplan-Meier curve showing better progression-free survival in the HPV–positive group (P value, log-rank test < .0001).

  • FIG 3.
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    FIG 3.

    Kaplan-Meier curve showing better overall survival in the HPV–positive group (P value, log–rank test < .0001).

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    FIG 4.

    Kaplan-Meier curve showing better progression-free survival in the group with ADC lower than the median value (P value, log–rank test < .0001).

Tables

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    Table 1:

    Baseline patient and tumor characteristics

    Total (n = 59)HPV+ (n = 28)HPV– (n = 31)P Value
    Age (yr)66.366.267.4.9
    Sex
     Male431924.41
     Female1697
    Smoker34/598/2826/31<.0001
    Site38, Palatine tonsil20, Palatine tonsil18, Palatine tonsil.61
    17, Tongue base7, Tongue base10, Tongue base
    3, Soft palate1, Soft palate2, Soft palate
    1, Posterior wall1, Posterior wall
    TNM classification
     TT2 = 25T2 = 16T2 = 9.08
    T3 = 2T3 = 1T3 = 1
    T4 = 32T4 = 11T4 = 21 (16, T4a; 5, T4b)
     NN0 = 14N0 = 7N0 = 7.002
    N1 = 15N1 = 13N1 = 2
    N2 = 18N2 = 6N2 = 12 (8, N2b; 4, N2c)
    N3 = 12N3 = 2N3 = 10 (N3b = 10)
     MM0 = 57M0 = 27M0 = 30.14
    M1 = 2M1 = 1M1 = 1
    • Note:—HPV+ indicates human papillomavirus–positive; HPV–, human papillomavirus–negative.

    • View popup
    Table 2:

    Univariable analysis for PFS and OS

    HR95% CIP ValueCorrected P Value
    PFS, univariate analysis
     HPV0.270.11–0.67.01.03
     Mean ADC (961.37 ± 184)1.001.00–1.00.01.03
     SD ADC (186.64 ± 54.32)1.000.9966–1.0115.29.44
     Kurtosis ADC (2.08 ± 2.17)1.080.87–1.34.50.50
     Skewness ADC (0.86 ± 0.76)0.810.45–1.45.48.50
     Entropy ADC (184 ± 0.5)1.900.78–4.67.16.32
    OS, univariate analysis
     HPV0.210.06–0.76.02.10
     Mean ADC1.000.999–1.004.2.34
     SD ADC0.10.985–1.005.34.34
     Kurtosis ADC1.150.89–1.15.3.34
     Skewness ADC0.690.35–1.35.28.34
     Entropy ADC2.750.9–8.43.08.23
    • Note:—HR indicates hazard ratio.

    • View popup
    Table 3:

    Survival analysis for PFS and OS, dividing the group on the basis of HPV status

    ADCHPV-Positive P ValueHPV-Negative P Value
    DFS
     Mean (961.37 ± 184).27.40
     SD (186.64 ± 54.32).79.79
     Kurtosis (2.08 ± 2.17).17.98
     Skewness (0.86 ± 0.76).53.79
     Entropy (184 ± 0.5).63.24
    OS
     Mean.14.37
     SD.24.13
     Kurtosis.57.14
     Skewness.06.65
     Entropy.19.01a
    • Note:—DFS indicates disease-free survival.

    • ↵a OR = 4.8461; 95% CI, 1.3507–17.3868.

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    Table 4:

    Studies investigating the relationship between pretreatment ADC and outcome after chemoradiation therapy in head and neck cancer

    ReferenceYear of PublicationNo. of PatientsNo. of Patients with OPSCCHPV Status AvailableHigh ADC Associated with
    Kim et al1520093322NPoor outcome
    Hatakenaka et al1620115722NPoor outcome
    Ohnishi et al1720116430NPoor outcome
    Srinivasan et al1820122011NPoor outcome
    Nakajo et al192012268NBetter outcome
    King et al2020133714NPoor outcome
    Chawla et al212013329NPoor outcome
    Lambrecht et al22201416185NPoor outcome
    Ng et al2320166937NPoor outcome
    Noij et al2420157840NPoor outcome
    Preda et al2520165711NaPoor outcome
    Marzi et al2620173414N/YbPoor outcome
    Lombardi et al2720174719NPoor outcome
    Martens et al28201913496YPoor outcomec
    • Note:—N indicates no; Y, yes.

    • ↵a Minimum ADC value within the ROI.

    • ↵b Only for the small cohort of patients with OPSCC.

    • ↵c Maximum ADC value within the ROI.

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M. Ravanelli, A. Grammatica, M. Maddalo, M. Ramanzin, G.M. Agazzi, E. Tononcelli, S. Battocchio, P. Bossi, M. Vezzoli, R. Maroldi, D. Farina
Pretreatment DWI with Histogram Analysis of the ADC in Predicting the Outcome of Advanced Oropharyngeal Cancer with Known Human Papillomavirus Status Treated with Chemoradiation
American Journal of Neuroradiology Jul 2020, DOI: 10.3174/ajnr.A6695

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Pretreatment DWI with Histogram Analysis of the ADC in Predicting the Outcome of Advanced Oropharyngeal Cancer with Known Human Papillomavirus Status Treated with Chemoradiation
M. Ravanelli, A. Grammatica, M. Maddalo, M. Ramanzin, G.M. Agazzi, E. Tononcelli, S. Battocchio, P. Bossi, M. Vezzoli, R. Maroldi, D. Farina
American Journal of Neuroradiology Jul 2020, DOI: 10.3174/ajnr.A6695
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