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Pretreatment Mean Apparent Diffusion Coefficient Is Significantly Correlated With Event-Free Survival in Patients With International Federation of Gynecology and Obstetrics Stage Ib to IIIb Cervical Cancer
  1. Yuki Himoto, MD*,
  2. Koji Fujimoto, MD, PhD*,
  3. Aki Kido, MD, PhD*,
  4. Tsukasa Baba, MD, PhD,
  5. Shiro Tanaka, PhD,
  6. Nobuko Morisawa, MD*,
  7. Sho Koyasu, MD*,
  8. Ikuo Konishi, MD, PhD and
  9. Kaori Togashi, MD, PhD*
  1. *Departments of Diagnostic Imaging and Nuclear Medicine and
  2. Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, Kyoto, Japan; and
  3. Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan.
  1. Address correspondence and reprint requests to Koji Fujimoto, MD, PhD, Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan. E-mail: kfb{at}


Objectives To assess the prognostic impact of the pretreatment mean apparent diffusion coefficient (ADCmean) values of tumors obtained by diffusion-weighted magnetic resonance imaging. We evaluated the prognostic value of the ADCmean for event-free survival (EFS) and overall survival (OS) among patients with uterine cervical cancer.

Methods/Materials We included 171 patients diagnosed as having International Federation of Gynecology and Obstetrics stage Ib to IIIb cervical cancer by pretreatment magnetic resonance imaging scans, regardless of therapeutic methods. In all patients and in patients with squamous cell carcinoma (SCC; n = 123), the optimal cutoff values of the tumor ADCmean for EFS and for OS were determined, respectively. The prognostic significance of the ADCmean was evaluated using univariate and multivariate Cox regression analyses.

Results In the univariate analyses, the ADCmean values were significantly associated with negative effects on EFS both in all patients and in patients with SCC, while not being significantly associated with OS in both groups. In the multivariate analysis, ADCmean was an independent biomarker for EFS (P < 0.05) in patients with SCC along with lymph node metastasis and definitive surgery, whereas ADCmean was not independently significant in EFS in all patients.

Conclusions The pretreatment ADCmean value of the tumor was an independent prognostic factor for EFS in International Federation of Gynecology and Obstetrics stage Ib to III SCC of the uterine cervix.

  • Cervical cancer
  • Prognostic factor
  • Magnetic resonance imaging
  • Apparent diffusion coefficient

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  • The authors declare no conflicts of interest.