Department of Radiology, Reims University Hospital, 45 rue Cognacq-jay, 51092, Reims, France.
Department of Radiology, Henri Mondor University Hospital, Créteil, France.
Eur Radiol. 2019 Jun;29(6):3183-3191. doi: 10.1007/s00330-018-5933-x. Epub 2019 Jan 15.
To determine whether texture analysis features on pretreatment contrast-enhanced computed tomography (CT) images can predict overall survival (OS) and progression-free survival (PFS) in patients with metastatic malignant melanoma (MM) treated with an anti-PD-1 monoclonal antibody, pembrolizumab.
This institutional-approved retrospective study included 31 patients with metastatic MM treated with pembrolizumab. Texture analysis of 74 metastatic lesions was performed on CT scanners obtained within 1 month before treatment. Mean gray-level, entropy, kurtosis, skewness, and standard deviation values were derived from the pixel distribution histogram before and after spatial filtration at different anatomic scales, ranging from fine to coarse. Lasso penalized Cox regression analyses were performed to identify independent predictors of OS and PFS.
Median OS and PFS were 357 days (range 42-1355) and 99 days (range 35-1185), respectively. Skewness at coarse texture scale (SSF = 6; HR (CI 95%) = 6.017 (1.39, 26.056), p = 0.016), Response evaluation criteria in solid tumors (RECIST) conclusion (HR (CI 95%) = 3.41 (1.17, 9.89), p = 0.024), and body weight (HR (CI 95%) = 0.96 (0.92, 0.995), p = 0.026) were independent predictors of OS. Skewness at coarse texture scale (SSF = 6; HR (CI 95%) = 4.55 (1.46, 14.13), p = 0.0089) and RECIST conclusion (HR (CI 95%) = 10.63 (3.11, 36.29), p = 0.00016) were independent predictors of PFS. Skewness values above - 0.55 at coarse texture scale were significantly associated with both lower OS and lower PFS after administration of pembrolizumab.
Pretreatment CT texture analysis-derived tumor skewness may act as predictive biomarker of OS and PFS in patients with metastatic MM treated with pembrolizumab.
• Pretreatment skewness at coarse texture scale in metastases from malignant melanoma was an independent predictor of overall survival and progression-free survival. • Skewness values above -0.55 at coarse texture scale were significantly associated with both lower OS and lower PFS after administration of pembrolizumab. • In patients with metastatic MM, texture analysis performed on pretreatment CT may act as a useful tool to select the best candidates for pembrolizumab therapy.
在接受抗 PD-1 单克隆抗体 pembrolizumab 治疗的转移性恶性黑色素瘤（MM）患者中，确定治疗前对比增强 CT（CT）图像的纹理分析特征是否可以预测总生存期（OS）和无进展生存期（PFS）。
本机构批准的回顾性研究纳入了 31 名接受 pembrolizumab 治疗的转移性 MM 患者。在治疗前 1 个月内在 CT 扫描仪上对 74 个转移性病变进行纹理分析。从像素分布直方图中得出治疗前和治疗后不同解剖尺度（从细到粗）的均值灰度、熵、峰度、偏度和标准差值。使用套索惩罚 Cox 回归分析来确定 OS 和 PFS 的独立预测因素。
中位 OS 和 PFS 分别为 357 天（范围 42-1355）和 99 天（范围 35-1185）。粗纹理尺度上的偏度（SSF=6；HR（95%CI）=6.017（1.39，26.056），p=0.016）、实体瘤反应评估标准（RECIST）结论（HR（95%CI）=3.41（1.17，9.89），p=0.024）和体重（HR（95%CI）=0.96（0.92，0.995），p=0.026）是 OS 的独立预测因素。粗纹理尺度上的偏度（SSF=6；HR（95%CI）=4.55（1.46，14.13），p=0.0089）和 RECIST 结论（HR（95%CI）=10.63（3.11，36.29），p=0.00016）是 PFS 的独立预测因素。粗纹理尺度上的偏度值大于-0.55 与 pembrolizumab 治疗后较低的 OS 和较低的 PFS 显著相关。
转移性黑色素瘤治疗前 CT 纹理分析衍生的肿瘤偏度可作为 pembrolizumab 治疗转移性 MM 患者 OS 和 PFS 的预测生物标志物。
• 黑色素瘤转移灶的粗纹理尺度上的治疗前偏度是总生存期和无进展生存期的独立预测因素。• 粗纹理尺度上的偏度值大于-0.55 与 pembrolizumab 治疗后较低的 OS 和较低的 PFS 显著相关。• 在转移性 MM 患者中，治疗前 CT 纹理分析可能是选择 pembrolizumab 治疗最佳患者的有用工具。
