BACKGROUND: The purpose of the study was to evaluate whether histogram analysis of apparent diffusion coefficient (ADC) can predict pathological complete response (pCR) and survival in patients with esophageal squamous cell carcinoma (ESCC) after chemoradiotherapy (CRT). METHODS: We retrospectively identified 58 patients with ESCC who underwent surgery after CRT between 2007 and 2016. Associations of pretreatment histogram derived ADC parameters with pathological response and survival were analyzed. RESULTS: Tumors achieved pCR (10 patients, 17.2%) showed significant lower ADC, higher kurtosis, and higher skewness than those of non-pCR (p = 0.005, 0.007, <0.001, respectively). Receiver operating characteristics analysis demonstrated skewness was the best predictor for pCR (AUC = 0.86), with a cut off value of 0.50 (accuracy, 86.2%). In Kaplan-Meier analysis, patients with higher skewness tumors (≥0.50) showed a significantly better recurrence free survival (p = 0.032, log-rank). CONCLUSIONS: Histogram analysis of ADC can enable prediction of pCR and survival in ESCC patients treated with preoperative CRT. A SHORT SUMMARY: ADC histogram analysis can be an imaging biomarker for esophageal cancer patients treated with CRT.
BACKGROUND: The purpose of the study was to evaluate whether histogram analysis of apparent diffusion coefficient (ADC) can predict pathological complete response (pCR) and survival in patients with esophageal squamous cell carcinoma (ESCC) after chemoradiotherapy (CRT). METHODS: We retrospectively identified 58 patients with ESCC who underwent surgery after CRT between 2007 and 2016. Associations of pretreatment histogram derived ADC parameters with pathological response and survival were analyzed. RESULTS:Tumors achieved pCR (10 patients, 17.2%) showed significant lower ADC, higher kurtosis, and higher skewness than those of non-pCR (p = 0.005, 0.007, <0.001, respectively). Receiver operating characteristics analysis demonstrated skewness was the best predictor for pCR (AUC = 0.86), with a cut off value of 0.50 (accuracy, 86.2%). In Kaplan-Meier analysis, patients with higher skewness tumors (≥0.50) showed a significantly better recurrence free survival (p = 0.032, log-rank). CONCLUSIONS: Histogram analysis of ADC can enable prediction of pCR and survival in ESCC patients treated with preoperative CRT. A SHORT SUMMARY: ADC histogram analysis can be an imaging biomarker for esophageal cancerpatients treated with CRT.