Clinical and Translational Radiation Oncology (Nov 2024)

Systemic inflammatory markers and volume of enhancing tissue on post-contrast T1w MRI images in differentiating true tumor progression from pseudoprogression in high-grade glioma

  • Camilla Satragno,
  • Irene Schiavetti,
  • Eugenia Cella,
  • Federica Picichè,
  • Laura Falcitano,
  • Martina Resaz,
  • Monica Truffelli,
  • Stefano Caneva,
  • Pietro Mattioli,
  • Daniela Esposito,
  • Alessio Ginulla,
  • Claudio Scaffidi,
  • Pietro Fiaschi,
  • Alessandro D’Andrea,
  • Andrea Bianconi,
  • Gianluigi Zona,
  • Laura Barletta,
  • Luca Roccatagliata,
  • Lucio Castellan,
  • Silvia Morbelli,
  • Matteo Bauckneht,
  • Isabella Donegani,
  • Paolo Nozza,
  • Dario Arnaldi,
  • Giulia Vidano,
  • Flavio Gianelli,
  • Salvina Barra,
  • Elisa Bennicelli,
  • Liliana Belgioia

Journal volume & issue
Vol. 49
p. 100849

Abstract

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Background: High-grade glioma (HGG) patients post-radiotherapy often face challenges distinguishing true tumor progression (TTP) from pseudoprogression (PsP). This study evaluates the effectiveness of systemic inflammatory markers and volume of enhancing tissue on post-contrast T1 weighted (T1WCE) MRI images for this differentiation within the first six months after treatment. Material and Methods: We conducted a retrospective analysis on a cohort of HGG patients from 2015 to 2021, categorized per WHO 2016 and 2021 criteria. We analyzed treatment responses using modified RANO criteria and conducted volumetry on T1WCE and T2W/FLAIR images.Blood parameters assessed included neutrophil/lymphocyte ratio (NLR), systemic immune-inflammation index (SII), and systemic inflammation response index (SIRI). We employed Chi-square, Fisher’s exact test, and Mann-Whitney U test for statistical analyses, using log-transformed predictors due to multicollinearity. A Cox regression analysis assessed the impact of PsP- and TTP-related factors on overall survival (OS). Results: The cohort consisted of 39 patients, where 16 exhibited PsP and 23 showed TTP. Univariate analysis revealed significantly higher NLR and SII in the TTP group [NLR: 4.1 vs 7.3, p = 0.002; SII 546.5 vs 890.5p = 0.009]. T1WCE volume distinctly differentiated PsP from TTP [2.2 vs 11.7, p < 0.001]. In multivariate regression, significant predictors included NLR and T1WCE volume in the “NLR Model,” and T1WCE volume and SII in the “SII Model.” The study also found a significantly lower OS rate in TTP patients compared to those with PsP [HR 3.97, CI 1.59 to 9.93, p = 0.003]. Conclusion: Elevated both, SII and NLR, and increased T1WCE volume were effective in differentiating TTP from PsP in HGG patients post-radiotherapy. These results suggest the potential utility of incorporating these markers into clinical practice, though further research is necessary to confirm these findings in larger patient cohorts.

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