A DWI-based hypoxia model shows robustness in an external prostatectomy cohort

M Fernandez Salamanca; T Hompland; M Deręgowska-Cylke; H Van der Poel; E Bekers; M A S Guimaraes; H Lyng; U A Van der Heide; I G Schoots; P J Van Houdt

doi:10.3389/fonc.2024.1433197

A DWI-based hypoxia model shows robustness in an external prostatectomy cohort

Front Oncol. 2024 Jul 23:14:1433197. doi: 10.3389/fonc.2024.1433197. eCollection 2024.

Authors

M Fernandez Salamanca¹, T Hompland², M Deręgowska-Cylke³, H Van der Poel^{4

5}, E Bekers⁶, M A S Guimaraes⁶, H Lyng^{2

7}, U A Van der Heide⁸, I G Schoots^{1

9}, P J Van Houdt⁸

Affiliations

¹ Department of Radiology, The Netherlands Cancer Institute, Amsterdam, Netherlands.
² Department of Radiation Biology, Oslo University Hospital, Oslo, Norway.
³ Department of Radiology, Medical University of Warsaw, Warsaw, Poland.
⁴ Department of Urology, The Netherlands Cancer Institute, Amsterdam, Netherlands.
⁵ Department of Urology, Amsterdam University Medical Centers, Amsterdam, Netherlands.
⁶ Department of Pathology, The Netherlands Cancer Institute, Amsterdam, Netherlands.
⁷ Department of Physics, University of Oslo, Oslo, Norway.
⁸ Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, Netherlands.
⁹ Department of Radiology & Nuclear Medicine, Erasmus University Medical Center, Rotterdam, Netherlands.

Abstract

Introduction: Prostate cancer hypoxia is a negative prognostic biomarker. A promising MRI-based tool to assess hypoxia is the 'Consumption and Supply based Hypoxia' (CSH) model based on diffusion-weighted imaging (DWI). The aim of the study was to validate the association between the CSH hypoxia fraction (HF_DWI) with pathological Grade Group (pGG) and pathological T-staging (pTstage) in an external prostatectomy cohort.

Methods: Apparent diffusion coefficient (ADC) and fractional blood volume (fBV) maps were assessed from DWI data from 291 prostatectomies and combined by the CSH model. HF_DWI was calculated for each lesion after median scaling of ADC and fBV to address differences in acquisition and analysis between centers. The absolute HF_DWI values and the associations of HF_DWI between pGG < 3 versus ≥ 3, and pTstage = 2 versus = 3 in the Netherlands Cancer Institute (NKI) cohort were compared to the obtained by original cohort (Oslo cohort). Statistical T- and Mann-Whitney tests (p<0.05) were performed. Pearson correlation was determined between HF_DWI and individual pGG groups.

Results: The HF_DWI showed comparable absolute values and similar metric performance as in the original published cohort. Higher HF_DWI values were observed for higher pGG (Oslo: 0.27; NKI: 0.24) compared to lower pGG (Oslo: 0.11; NKI: 0.17). Similar results were obtained for pTstage. Furthermore, HF_DWI demonstrated a significant positive correlation with pGG groups 1-5 (ρ = 0.41, p<0.001).

Conclusion: The CSH model exhibited sufficient robustness in the external cohort, suggesting a plausible reflection of true hypoxia and enabling the use of the HF_DWI metric for further research into prostate cancer and hypoxia.

Keywords: diffusion weighted images; hypoxia; hypoxia biomarker; prostate cancer; prostatectomy.

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This project has been founded by a KWF grant. Project number: 12975.