Low sADC Predicts Poor Outcomes in Cervical Cancer with PD-1 Inhibitors

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Frontiers in Medicine Published March 30, 2026 Medically reviewed April 26, 2026 DOI ↗ By Dr. Julia Lee, PhD · Oncology, Genomics & Drug Development

Key Takeaway

Use sADC to predict outcomes in cervical cancer patients on PD-1 inhibitors.

This retrospective study evaluated whether pre-treatment apparent diffusion coefficient (ADC) values from diffusion-weighted imaging could predict clinical outcomes in patients with advanced or locally advanced cervical cancer undergoing PD-1 inhibitor therapy. Conducted at Wuhan Union Hospital, the study included 167 patients treated between May 1, 2020, and December 31, 2023. Researchers measured whole tumor ADC (wADC) and substantial tumor ADC (sADC), which excludes necrotic, cystic, and vascular regions, on the largest tumor slice. Optimal cut-off values for ADC and inflammatory markers were determined using X-tile software based on overall survival (OS). The analysis revealed that a lower sADC was significantly associated with worse progression-free survival (PFS) and overall survival (OS), with hazard ratios of 1.81 (95% CI: 1.18-2.80, P=0.005) and 2.40 (95% CI: 1.36-4.21, P=0.002), respectively. In contrast, wADC did not show a significant prognostic correlation with PFS (HR=0.64, 95% CI: 0.39-1.06, P=0.123) or OS (HR=0.62, 95% CI: 0.32-1.19, P=0.209). Multivariate Cox regression confirmed low-sADC as an independent risk factor for both OS (HR=2.15, 95% CI: 1.14-4.03, P=0.017) and PFS (HR=1.70, 95% CI: 1.08-2.67, P=0.021). These findings suggest that sADC could serve as a prognostic biomarker in this patient population.

Study Details

Study typeCohort

EvidenceLevel 3

PublishedMar 2026

View Original Abstract ↓

BackgroundTo investigate whether pre-treatment apparent diffusion coefficient (ADC) values from diffusion-weighted imaging (DWI) predict clinical outcomes in patients with advanced or locally advanced cervical cancer undergoing Programmed Death-1 (PD-1) inhibitor therapy. Despite the growing use of immunotherapy, reliable and non-invasive imaging biomarkers to predict treatment response in cervical cancer are lacking.MethodsThis retrospective study analyzed 167 cervical cancer patients treated with PD-1 inhibitors at Wuhan Union Hospital between 01/05/2020 and 31/12/2023. The whole tumor ADC (wADC) and substantial tumor ADC (sADC; excluding necrotic, cystic, and vascular regions) were measured on the largest tumor slice. Optimal cut-off values for ADC and inflammatory markers were determined using X-tile software based on overall survival (OS). Progression-free survival (PFS) and OS were analyzed using Kaplan-Meier curves and Cox regression models.ResultsLower sADC was associated with significantly worse PFS (hazard ratio [HR] = 1.81; 95% confidence interval [CI]: 1.18-2.80; P = 0.005) and OS (HR = 2.40; 95% CI: 1.36-4.21; P = 0.002), whereas wADC showed no significant prognostic correlation with PFS (HR = 0.64; 95% CI: 0.39-1.06; P = 0.123) and OS (HR = 0.62; 95% CI: 0.32-1.19; P = 0.209). Multivariate Cox regression revealed low-sADC as an independent risk factor for OS (HR = 2.15, 95% CI: 1.14-4.03, P = 0.017) and PFS (HR = 1.70, 95% CI: 1.08-2.67, P = 0.021).ConclusionThe substantial tumor ADC (excluding necrotic, cystic, and vascular regions) was associated with prognosis in cervical cancer patients receiving PD-1 inhibitor therapy.