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Apparent Diffusion Coefficient on Diffusion-Weighted Magnetic Resonance Imaging to Predict the Prognosis of Patients with Endometrial Cancer: A Meta-Analysis

  • Gynecologic Oncology: Original Article
  • Published:
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Abstract

Apparent diffusion coefficient (ADC) derived from diffusion-weighted magnetic resonance imaging (DWI) may help diagnose endometrial cancer (EC). However, the association between ADC and the recurrence and survival of EC remains unknown. We performed a systematic review and meta-analysis to investigate whether pretreatment ADC on DWI could predict the prognosis of women with EC. PubMed, Embase, and Cochrane’s Library were searched for relevant cohort studies comparing the clinical outcomes between women with EC having low versus high ADC on pretreatment DWI. Two authors independently conducted data collection, literature searching, and statistical analysis. Using a heterogeneity-incorporating random-effects model, we analyzed the results. In the meta-analysis, 1358 women with EC were included from eight cohort studies and followed for a median duration of 40 months. Pooled results showed that a low pretreatment ADC on DWI was associated with poor disease-free survival (DFS, hazard ratio [HR]: 3.29, 95% CI: 2.04 to 5.31, p < 0.001; I2 = 41%). Subgroup analysis according to study design, tumor stage, MRI Tesla strength, ADC cutoff, follow-up duration, and study quality score showed consistent results (p for subgroup analysis all > 0.05). The predictive value of low ADC for poor DFS in women with EC decreased in multivariate studies compared to univariate studies (HR: 2.59 versus 32.57, p = 0.002). Further studies showed that a low ADC was also associated with poor overall survival (HR: 3.36, 95% CI: 1.33 to 8.50, p = 0.01, I2 = 0). In conclusion, a low ADC on pretreatment DWI examination may predict disease recurrence and survival in women with EC.

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Data Availability

The original contributions presented in the study are included in the article. Further inquiries can be directed to the corresponding author.

Code Availability

Not applicable.

Abbreviations

EC:

Endometrial cancer

DWI:

Diffusion-weighted magnetic resonance imaging

ADC:

Apparent diffusion coefficient

PRISMA:

Preferred Reporting Items for Systematic Reviews and Meta-Analyses

DFS:

Disease-free survival

OS:

Overall survival

HR:

Hazard ratio

CI:

Confidence interval

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Acknowledgements

None.

Funding

This work was supported by the Research Project of Qingdao University Medical Group Co., Ltd. (grant number YLJT20231003).

Author information

Author notes

  1. Deyin Zhai, **ujie Wang and Junlian Wang contributed equally to this work and share the first authorship.

Authors and Affiliations

  1. Department of Internal Medicine, Laizhou People’s Hospital, Laizhou, China

    Deyin Zhai

  2. Imaging Department, Zhaoyuan People’s Hospital, Zhaoyuan, China

    **ujie Wang

  3. Department of Nursing, Laizhou People’s Hospital, Laizhou, China

    Junlian Wang

  4. Imaging Department, Laizhou People’s Hospital, Laizhou, China

    Zheng Zhang

  5. Ultrasound Department, Laizhou People’s Hospital, Laizhou, China

    Yangang Sheng & Ruining Jiao

  6. Department of Radiation Oncology, Yantai Yuhuangding Hospital, Yantai, China

    Yihua Liu & Peng Liu

  7. Department of Radiation Oncology, Yantai Yuhuangding Hospital, 20 Yuhuangding East Road, Zhifu District, Yantai, China

    Yihua Liu & Peng Liu

Authors
  1. Deyin Zhai
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Contributions

Peng Liu, **ujie Wang, and Deyin Zhai designed the study; Yihua Liu, **ujie Wang, and Zheng Zhang performed database search, data collection, and study quality evaluation; Zheng Zhang, Yangang Sheng, Ruining Jiao, and Deyin Zhai performed statistical analysis; Peng Liu, Yihua Liu, and **ujie Wang interpreted the results; Junlian Wang and Deyin Zhai wrote the initial draft; **ujie Wang revised the manuscript; Peng Liu was the primary person responsible for the final content. All authors read and approved the final version of the manuscript.

Corresponding authors

Correspondence to Yihua Liu or Peng Liu.

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Zhai, D., Wang, X., Wang, J. et al. Apparent Diffusion Coefficient on Diffusion-Weighted Magnetic Resonance Imaging to Predict the Prognosis of Patients with Endometrial Cancer: A Meta-Analysis. Reprod. Sci. (2024). https://doi.org/10.1007/s43032-024-01595-8

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