Validation of Independent Prognostic Value of Asphericity of 18F-Fluorodeoxyglucose Uptake in Non–Small-Cell Lung Cancer Patients Undergoing Treatment With Curative Intent

Rogasch, J; Furth, Christian; Chibolela, Christoph; Hofheinz, Frank; Ochsenreither, Sebastian; Rückert, Jens-Carsten; Neudecker, Jens; Böhmer, Dirk; Laffert, Maximilian von; Amthauer, Holger; Frost, Nikolaj

doi:10.1016/j.cllc.2019.10.001

Cited by 6 publications

(27 citation statements)

References 22 publications

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“…Proportions (%) of discordantly classi ed cases (high vs. low ASP/SUVmax/MTV) between algorithms were given with their 95% binomial proportion con dence intervals (95%-CI) which included the continuity correction of ± 0.5/n ( = ± 0.5/50 = ± 1%). Classi cation with ASP (> 19.5%) was based on a previously identi ed cut-off in NSCLC patients (15)…”

Section: Discussionmentioning

confidence: 99%

“…If the primary tumor was determined to be multifocal (i.e. separate ipsilateral tumor nodules) or the presence of lymphangitic carcinomatosis was diagnosed by interdisciplinary consensus, all tumor nodules and FDG-avid lymphangitic tissue were included in the MTV (see also (15)). SUVmax and ASP of the MTV were derived.…”

Section: Data Evaluationmentioning

confidence: 99%

“…Among parameters from positron emission tomography/computed tomography with [ 18 F] uorodeoxyglucose (FDG-PET/CT), asphericity (ASP) is a parameter that re ects shape irregularity of the primary tumor's metabolic tumor volume (MTV), combining metric and metabolic features of the primary tumor. Three retrospective studies con rmed its independent prognostic value for progression-free (PFS) and overall survival (OS) in patients with NSCLC (13)(14)(15). The largest study (311 patients, UICC stage I-III) further showed that ASP, with an optimal cut-off of > 19.5%, could identify patients with UICC stage II treated by surgery and adjuvant chemotherapy with high ASP and reduced PFS (median, 11 months vs. not reached) and OS (22 months vs. not reached) (15).…”

Section: Introductionmentioning

confidence: 99%

“…Three retrospective studies con rmed its independent prognostic value for progression-free (PFS) and overall survival (OS) in patients with NSCLC (13)(14)(15). The largest study (311 patients, UICC stage I-III) further showed that ASP, with an optimal cut-off of > 19.5%, could identify patients with UICC stage II treated by surgery and adjuvant chemotherapy with high ASP and reduced PFS (median, 11 months vs. not reached) and OS (22 months vs. not reached) (15). ASP was superior for survival prediction compared to primary tumor's maximum standardized uptake value (SUVmax) and MTV, two other previously proposed and common PET parameters (8,9,16,17).…”

Section: Introductionmentioning

confidence: 99%

“…The focus was on the assessment if the resulting variation is acceptable for application in multicenter studies and on de ning the range of acceptable variation of the in uencing factors. To separate variability introduced by different reconstruction methods and variability caused by different delineation algorithms, all lesions were delineated using the same method as in the preceding studies on ASP in NSCLC (13)(14)(15). To facilitate interpretation, SUVmax and MTV were investigated analogously for comparison.…”

Section: Introductionmentioning

confidence: 99%

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Asphericity of Tumor FDG Uptake in Non-Small Cell Lung Cancer: Reproducibility and Implications for Harmonization in Multicenter Studies

Rogasch

Furth

Bluemel

et al. 2020

Preprint

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Background Asphericity (ASP) of the primary tumor’s metabolic tumor volume (MTV) in FDG-PET/CT is independently predictive for survival in patients with non-small cell lung cancer (NSCLC). However, comparability between PET systems may be limited. Therefore, reproducibility of ASP was evaluated at varying image reconstruction and acquisition times to assess feasibility of ASP assessment in multicenter studies. Methods Retrospective study of 50 patients with NSCLC (female, 20; median age, 69 years) undergoing pretherapeutic FDG-PET/CT (median, 3.7 MBq/kg; 180 s/bed position). Reconstruction used OSEM with TOF4/16 (iterations, 4; subsets, 16; in-plane filter, 2.0, 6.4 or 9.5 mm), TOF4/8 (4 it; 8 ss; filter, 2.0/6.0/9.5 mm), PSF + TOF2/17 (2 it; 17 ss; filter, 2.0/7.0/10.0 mm) or Bayesian penalized likelihood (Q.Clear; beta, 600/1750/4000). Resulting reconstructed spatial resolution (FWHM) was determined from hot sphere inserts of a NEMA IEC phantom. Data with approx. 5 mm FWHM were retrospectively smoothed to achieve 7 mm FWHM. List mode data were rebinned for acquisition times of 120/90/60 s. Threshold-based delineation of primary tumor MTV was followed by evaluation of relative ASP/SUVmax/MTV differences between datasets and resulting proportions of discordantly classified cases. Results Reconstructed resolution for narrow/medium/wide in-plane filter (or low/medium/high beta) was approx. 5/7/9 mm FWHM. Comparing different pairs of reconstructed resolution between TOF4/8, PSF + TOF2/17, Q.Clear and the reference algorithm TOF4/16, ASP differences were lowest at FWHM of 7 vs. 7 mm. Proportions of discordant cases (ASP > 19.5% vs. ≤19.5%) were also lowest at 7 mm (TOF4/8, 2%; PSF + TOF2/17, 4%; Q.Clear, 10%). Smoothing of 5 mm data to 7 mm FWHM significantly reduced discordant cases (TOF4/8, 38% reduced to 2%; PSF + TOF2/17, 12–4%; Q.Clear, 10–6%) resulting in proportions comparable to original 7 mm data. Shorter acquisition time only increased proportions of discordant cases at < 90 s. Conclusions ASP differences were mainly determined by reconstructed spatial resolution, and multicenter studies should aim at comparable FWHM (e.g., 7 mm; determined by in-plane filter width). This reduces discordant cases (high vs. low ASP) to an acceptable proportion for TOF and PSF + TOF of < 5% (Q.Clear: 10%). Data with better resolution (i.e. lower FWHM) could be retrospectively smoothed to the desired FWHM resulting in a comparable number of discordant cases.

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Section: Discussionmentioning

confidence: 99%

Section: Data Evaluationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Asphericity of Tumor FDG Uptake in Non-Small Cell Lung Cancer: Reproducibility and Implications for Harmonization in Multicenter Studies

Rogasch

Furth

Bluemel

et al. 2020

Preprint

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Asphericity derived from [18F]FDG PET as a new prognostic parameter in cervical cancer patients

Cegła

Hofheinz

Burchardt

et al. 2023

Sci Rep

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The objective of this study was to assess the prognostic value of asphericity (ASP) and standardized uptake ratio (SUR) in cervical cancer patients. Retrospective analysis was performed on a group of 508 (aged 55 ± 12 years) previously untreated cervical cancer patients. All patients underwent a pretreatment [18F]FDG PET/CT study to assess the severity of the disease. The metabolic tumor volume (MTV) of the cervical cancer was delineated with an adaptive threshold method. For the resulting ROIs the maximum standardized uptake value (SUVmax) was measured. In addition, ASP and SUR were determined as previously described. Univariate Cox regression and Kaplan–Meier analysis with respect to event free survival (EFS), overall survival (OS), freedom from distant metastasis (FFDM) and locoregional control (LRC) was performed. Additionally, a multivariate Cox regression including clinically relevant parameters was performed. In the survival analysis, MTV and ASP were shown to be prognostic factors for all investigated endpoints. Tumor metabolism quantified with the SUVmax was not prognostic for any of the endpoints (p > 0.2). The SUR did not reach statistical significance either (p = 0.1, 0.25, 0.066, 0.053, respectively). In the multivariate analysis, the ASP remained a significant factor for EFS and LRC, while MTV was a significant factor for FFDM, indicating their independent prognostic value for the respective endpoints. The alternative parameter ASP has the potential to improve the prognostic value of [18F]FDG PET/CT for event-free survival and locoregional control in radically treated cervical cancer patients.

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Combination of tumor asphericity and an extracellular matrix-related prognostic gene signature in non-small cell lung cancer patients

Zschaeck,

Klinger,

van den Hoff

et al. 2023

Sci Rep

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One important aim of precision oncology is a personalized treatment of patients. This can be achieved by various biomarkers, especially imaging parameters and gene expression signatures are commonly used. So far, combination approaches are sparse. The aim of the study was to independently validate the prognostic value of the novel positron emission tomography (PET) parameter tumor asphericity (ASP) in non small cell lung cancer (NSCLC) patients and to investigate associations between published gene expression profiles and ASP. This was a retrospective evaluation of PET imaging and gene expression data from three public databases and two institutional datasets. The whole cohort comprised 253 NSCLC patients, all treated with curative intent surgery. Clinical parameters, standard PET parameters and ASP were evaluated in all patients. Additional gene expression data were available for 120 patients. Univariate Cox regression and Kaplan–Meier analysis was performed for the primary endpoint progression-free survival (PFS) and additional endpoints. Furthermore, multivariate cox regression testing was performed including clinically significant parameters, ASP, and the extracellular matrix-related prognostic gene signature (EPPI). In the whole cohort, a significant association with PFS was observed for ASP (p < 0.001) and EPPI (p = 0.012). Upon multivariate testing, EPPI remained significantly associated with PFS (p = 0.018) in the subgroup of patients with additional gene expression data, while ASP was significantly associated with PFS in the whole cohort (p = 0.012). In stage II patients, ASP was significantly associated with PFS (p = 0.009), and a previously published cutoff value for ASP (19.5%) was successfully validated (p = 0.008). In patients with additional gene expression data, EPPI showed a significant association with PFS, too (p = 0.033). The exploratory combination of ASP and EPPI showed that the combinatory approach has potential to further improve patient stratification compared to the use of only one parameter. We report the first successful validation of EPPI and ASP in stage II NSCLC patients. The combination of both parameters seems to be a very promising approach for improvement of risk stratification in a group of patients with urgent need for a more personalized treatment approach.

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Validation of Independent Prognostic Value of Asphericity of 18F-Fluorodeoxyglucose Uptake in Non–Small-Cell Lung Cancer Patients Undergoing Treatment With Curative Intent

Cited by 6 publications

References 22 publications

Asphericity of Tumor FDG Uptake in Non-Small Cell Lung Cancer: Reproducibility and Implications for Harmonization in Multicenter Studies

Asphericity of Tumor FDG Uptake in Non-Small Cell Lung Cancer: Reproducibility and Implications for Harmonization in Multicenter Studies

Asphericity derived from [18F]FDG PET as a new prognostic parameter in cervical cancer patients

Combination of tumor asphericity and an extracellular matrix-related prognostic gene signature in non-small cell lung cancer patients

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