氟代脱氧葡萄糖正电子发射断层扫描/计算机断层扫描放射组学预测局部进展期直肠癌的结局。

FDG PET/CT radiomics for predicting the outcome of locally advanced rectal cancer.

机构信息

Division of Nuclear Medicine and Oncological Imaging, Department of Medical Physics CHU, University of Liège, B35 Domaine Universitaire du Sart-Tilman, 4000, Liege, Belgium.

Department of Gastro-enterology, Centre Hospitalier Universitaire de Liège, Liège, Belgium.

出版信息

Eur J Nucl Med Mol Imaging. 2018 Mar;45(3):365-375. doi: 10.1007/s00259-017-3855-5. Epub 2017 Oct 18.

DOI:10.1007/s00259-017-3855-5

PMID:29046927

Abstract

PURPOSE

The aim of this study was to investigate the prognostic value of baseline F-FDG PET/CT textural analysis in locally-advanced rectal cancer (LARC).

METHODS

Eighty-six patients with LARC underwent F-FDG PET/CT before treatment. Maximum and mean standard uptake values (SUVmax and SUVmean), metabolic tumoral volume (MTV), total lesion glycolysis (TLG), histogram-intensity features, as well as 11 local and regional textural features, were evaluated. The relationships of clinical, pathological and PET-derived metabolic parameters with disease-specific survival (DSS), disease-free survival (DFS) and overall survival (OS) were assessed by Cox regression analysis. Logistic regression was used to predict the pathological response by the Dworak tumor regression grade (TRG) in the 66 patients treated with neoadjuvant chemoradiotherapy (nCRT).

RESULTS

The median follow-up of patients was 41 months. Seventeen patients (19.7%) had recurrent disease and 18 (20.9 %) died, either due to cancer progression (n = 10) or from another cause while in complete remission (n = 8). DSS was 95% at 1 year, 93% at 2 years and 87% at 4 years. Weight loss, surgery and the texture parameter coarseness were significantly associated with DSS in multivariate analyses. DFS was 94 % at 1 year, 86 % at 2 years and 79 % at 4 years. From a multivariate standpoint, tumoral differentiation and the texture parameters homogeneity and coarseness were significantly associated with DFS. OS was 93% at 1 year, 87% at 2 years and 79% after 4 years. cT, surgery, SUVmean, dissimilarity and contrast from the neighborhood intensity-difference matrix (contrast) were significantly and independently associated with OS. Finally, RAS-mutational status (KRAS and NRAS mutations) and TLG were significant predictors of pathological response to nCRT (TRG 3-4).

CONCLUSION

Textural analysis of baseline F-FDG PET/CT provides strong independent predictors of survival in patients with LARC, with better predictive power than intensity- and volume-based parameters. The utility of such features, especially coarseness, should be confirmed by larger clinical studies before considering their potential integration into decisional algorithms aimed at personalized medicine.

摘要

目的

本研究旨在探讨基线 F-FDG PET/CT 纹理分析在局部晚期直肠癌（LARC）中的预后价值。

方法

86 例 LARC 患者在治疗前接受 F-FDG PET/CT 检查。评估最大标准摄取值（SUVmax 和 SUVmean）、代谢肿瘤体积（MTV）、总肿瘤糖酵解（TLG）、直方图强度特征以及 11 个局部和区域纹理特征。采用 Cox 回归分析评估临床、病理和 PET 代谢参数与疾病特异性生存（DSS）、无病生存（DFS）和总生存（OS）的关系。采用逻辑回归预测 66 例接受新辅助放化疗（nCRT）治疗患者的病理反应（Dworak 肿瘤消退分级（TRG））。

结果

患者中位随访时间为 41 个月。17 例（19.7%）患者出现疾病复发，18 例（20.9%）患者因癌症进展（n=10）或完全缓解时死于其他原因（n=8）而死亡。1 年、2 年和 4 年时 DSS 分别为 95%、93%和 87%。体重减轻、手术和纹理参数粗糙度在多变量分析中与 DSS 显著相关。DFS 为 1 年时 94%、2 年时 86%、4 年时 79%。从多变量角度看，肿瘤分化以及纹理参数均匀度和粗糙度与 DFS 显著相关。OS 为 1 年时 93%、2 年时 87%、4 年后为 79%。cT、手术、SUVmean、从邻域强度差矩阵（contrast）中获得的不相似性和对比度与 OS 显著相关。最后，RAS 突变状态（KRAS 和 NRAS 突变）和 TLG 是 nCRT 病理反应（TRG 3-4）的显著预测因子。