Relative Wash-In Rate in Dynamic Contrast-Enhanced Magnetic Resonance Imaging as a New Prognostic Biomarker for Event-Free Survival in 82 Patients with Osteosarcoma: A Multicenter Study

• Published in: Cancers Vol. 16; no. 11; p. 1954
• Main Authors: Kalisvaart, Gijsbert M, Evenhuis, Richard E, Grootjans, Willem, Van Den Berghe, Thomas, Callens, Martijn, Bovée, Judith V M G, Creytens, David, Gelderblom, Hans, Speetjens, Frank M, Lapeire, Lore, Sys, Gwen, Fiocco, Marta, Verstraete, Koenraad L, van de Sande, Michiel A J, Bloem, Johan L
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 21.05.2024; MDPI
• Subjects: Adjuvant treatment; Age groups; Biomarkers; Bone cancer; Cancer; Chemotherapy; Clinical outcomes; Health care; Magnetic resonance imaging; Medical prognosis; Medical research; Medicine, Experimental; Metastases; Metastasis; Osteosarcoma; Patient outcomes; Patients; Radiation therapy; Variables; Belgium; Netherlands; neoadjuvant chemotherapy; survival outcome; response monitoring; dynamic contrast-enhanced MRI; osteosarcoma; histological response
• ISSN: 2072-6694; 2072-6694
• DOI: 10.3390/cancers16111954

The decreased perfusion of osteosarcoma in dynamic contrast-enhanced (DCE) MRI, reflecting a good histological response to neoadjuvant chemotherapy, has been described. In this study, we aim to explore the potential of the relative wash-in rate as a prognostic factor for event-free survival (EFS). Skeletal high-grade osteosarcoma patients, treated in two tertiary referral centers between 2005 and 2022, were retrospectively included. The relative wash-in rate (rWIR) was determined with DCE-MRI before, after, or during the second cycle of chemotherapy (pre-resection). A previously determined cut-off was used to categorize patients, where rWIR < 2.3 was considered poor and rWIR ≥ 2.3 a good radiological response. EFS was defined as the time from resection to the first event: local recurrence, new metastases, or tumor-related death. EFS was estimated using Kaplan-Meier's methodology. Multivariate Cox proportional hazard model was used to estimate the effect of histological response and rWIR on EFS, adjusted for traditional prognostic factors. Eighty-two patients (median age: 17 years; IQR: 14-28) were included. The median follow-up duration was 11.8 years (95% CI: 11.0-12.7). During follow-up, 33 events occurred. Poor histological response was not significantly associated with EFS (HR: 1.8; 95% CI: 0.9-3.8), whereas a poor radiological response was associated with a worse EFS (HR: 2.4; 95% CI: 1.1-5.0). In a subpopulation without initial metastases, the binary assessment of rWIR approached statistical significance (HR: 2.3; 95% CI: 1.0-5.2), whereas its continuous evaluation demonstrated a significant association between higher rWIR and improved EFS (HR: 0.7; 95% CI: 0.5-0.9), underlining the effect of response to chemotherapy. The 2- and 5-year EFS for patients with a rWIR ≥ 2.3 were 85% and 75% versus 55% and 50% for patients with a rWIR < 2.3. The predicted poor chemo response with MRI (rWIR < 2.3) is associated with shorter EFS even when adjusted for known clinical covariates and shows similar results to histological response evaluation. rWIR is a potential tool for future response-based individualized healthcare in osteosarcoma patients before surgical resection.