AUTHOR=He Kangwen , Zhang Yucong , Li Shichao , Yuan Guanjie , Liang Ping , Zhang Qingpeng , Xie Qingguo , Xiao Peng , Li Heng , Meng Xiaoyan , Li Zhen 

TITLE=Incremental prognostic value of ADC histogram analysis in patients with high-risk prostate cancer receiving adjuvant hormonal therapy after radical prostatectomy

JOURNAL=Frontiers in Oncology

VOLUME=13

YEAR=2023

URL=https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2023.1076400

DOI=10.3389/fonc.2023.1076400

ISSN=2234-943X

ABSTRACT=<sec><title>Purpose</title><p>To investigate the incremental prognostic value of preoperative apparent diffusion coefficient (ADC) histogram analysis in patients with high-risk prostate cancer (PCa) who received adjuvant hormonal therapy (AHT) after radical prostatectomy (RP).</p></sec><sec><title>Methods</title><p>Sixty-two PCa patients in line with the criteria were enrolled in this study. The 10<sup>th</sup>, 50<sup>th</sup>, and 90<sup>th</sup> percentiles of ADC (ADC<sub>10</sub>, ADC<sub>50</sub>, ADC<sub>90</sub>), the mean value of ADC (ADC<sub>mean</sub>), kurtosis, and skewness were obtained from the whole-lesion ADC histogram. The Kaplan–Meier method and Cox regression analysis were used to analyze the relationship between biochemical recurrence-free survival (BCR-fs) and ADC parameters and other clinicopathological factors. Prognostic models were constructed with and without ADC parameters.</p></sec><sec><title>Results</title><p>The median follow-up time was 53.4 months (range, 41.1-79.3 months). BCR was found in 19 (30.6%) patients. Kaplan−Meier curves showed that lower ADC<sub>mean</sub>, ADC<sub>10</sub>, ADC<sub>50</sub>, and ADC<sub>90</sub> and higher kurtosis could predict poorer BCR-fs (all <italic>p</italic>&lt;0.05). After adjusting for clinical parameters, ADC<sub>50</sub> and kurtosis remained independent prognostic factors for BCR-fs (HR: 0.172, 95% CI: 0.055-0.541, <italic>p</italic>=0.003; HR: 7.058, 95% CI: 2.288-21.773, <italic>p</italic>=0.001, respectively). By adding ADC parameters to the clinical model, the C index and diagnostic accuracy for the 24- and 36-month BCR-fs were improved.</p></sec><sec><title>Conclusion</title><p>ADC histogram analysis has incremental prognostic value in patients with high-risk PCa who received AHT after RP. Combining ADC<sub>50</sub>, kurtosis and clinical parameters can improve the accuracy of BCR-fs prediction.</p></sec>