Incorporating radiomic feature of pretreatment 18F-FDG PET improves survival stratification in patients with EGFR-mutated lung adenocarcinoma

Abstract

Background To investigate the survival prognostic value of the radiomic features of 18F-FDG PET in patients who had EGFR (epidermal growth factor receptor) mutated lung adenocarcinoma and received targeted TKI (tyrosine kinase inhibitor) treatment. Methods Fifty-one patients with stage III-IV lung adenocarcinoma and actionable EGFR mutation who received first-line TKI were retrospectively analyzed. All patients underwent pretreatment 18F-FDG PET/CT, and we calculated the PET-derived radiomic features. Cox proportional hazard model was used to examine the association between the radiomic features and the survival outcomes, including progression-free survival (PFS) and overall survival (OS). A score model was established according to the independent prognostic predictors and we compared this model to the TNM staging system using Harrell's concordance index (c-index). Results Forty-eight patients (94.1%) experienced disease progression and 41 patients (80.4%) died. Primary tumor SUV entropy > 5.36, and presence of pleural effusion were independently associated with worse OS (both p < 0.001) and PFS (p = 0.001, and 0.003, respectively). We used these two survival predictors to devise a scoring system (score 0–2). Patients with a score of 1 or 2 had a worse survival than those with a score of 0 (HR for OS: 3.6, p = 0.006 for score 1, and HR: 21.8, p < 0.001 for score 2; HR for PFS: 2.2, p = 0.027 for score 1 and HR: 8.8, p < 0.001 for score 2). Our scoring system surpassed the TNM staging system (c-index = 0.691 versus 0.574, p = 0.013 for OS, and c-index = 0.649 versus 0.517, p = 0.004 for PFS). Conclusions In this preliminary study, combining PET radiomics with clinical risk factors may improve survival stratification in stage III-IV lung adenocarcinoma with actionable EFGR mutation. Our proposed scoring system may assist with optimization of individualized treatment strategies in these patients.

Prognostic Value of Combing Primary Tumor and Nodal Glycolytic–Volumetric Parameters of 18F-FDG PET in Patients with Non-Small Cell Lung Cancer and Regional Lymph Node Metastasis

“…Therefore, a more reliable prognostic stratification tool is an unmet need. The prognostic value of 18 F-FDG PET parameters derived from the primary tumor or the regional lymph node has been reported in patients with NSCLC [18][19][20]33,34]. However, the predictive power of combining the 18 F-FDG PET parameters from both primary tumor and metastatic nodes has not been well investigated.…”

“…The validation process was executed using SPSS software (version 20.0; SPSS Inc., Chicago, IL, USA). The performance of our Cox regression models was assessed and compared with the AJCC staging system using Harrell's concordance index (c-index) and Kaplan-Meier curves (log-rank test) [19,31]. Different c-indices were compared using the "compareC" package installed on the R open-source statistical software version 3.4.2 (R Foundation, Vienna, Austria).…”

“…Several 18 F-FDG PET semiquantitative parameters have been developed to quantify the glycolytic activity and metabolic volume of tumors, including standardized uptake value (SUV) and volumetric parameters such as the metabolic tumor volume (MTV) and total lesion glycolysis (TLG). Higher metabolic activity and larger metabolic burdens are associated with worse survival outcomes; thus, many studies have focused on the use of 18 F-FDG PET-derived semiquantitative parameters as prognostic biomarkers to predict survival outcomes in patients with NSCLC [15,[18][19][20][21]. In addition, the semiquantitative 18 F-FDG PET parameters can not only be derived from the primary tumor but can also be measured from the metastatic nodes, as the genotypes and the consequent phenotypes may not be the same in the metastatic lesions and primary tumors [22,23].…”

The Role of Histogram-Based Textural Analysis of ¹⁸F-FDG PET/CT in Evaluating Tumor Heterogeneity and Predicting the Prognosis of Invasive Lung Adenocarcinoma

“…A study that involve patients with advanced lung adenocarcinoma with epidermal growth factor receptor mutation who received tyrosine kinase inhibitor therapy revealed a shorter survival in patients with primary tumors with high entropy values. Additionally, they reported that entropy value is an independent predictor of treatment response and decreases after treatment ( 22 ). According to Hyun et al ( 23 ) lower entropy was independently associated with longer survival in patients with pancreatic ductal adenocarcinoma.…”

Systemic Inflammation Index and Tumor Glycolytic Heterogeneity Help Risk Stratify Patients with Advanced Epidermal Growth Factor Receptor-Mutated Lung Adenocarcinoma Treated with Tyrosine Kinase Inhibitor Therapy

“…Distinct from the clinical profile and cancer staging system, which pictures the disease to a greater extent, texture analysis portrays more associations with aspects of tumor behavior. An increasing number of recent studies have demonstrated that tumor entropy is a robust predictor of survival in patients with lung cancer [ 25 , 26 , 27 , 28 , 29 ]. However, little is known about the comparison and potential combinations of hematologic inflammation biomarkers and tumor glycolytic heterogeneity in the current clinical setting.…”