MRI 放射组学特征与免疫检查点抑制剂治疗的黑色素瘤脑转移患者的生存相关。
MRI radiomic features are associated with survival in melanoma brain metastases treated with immune checkpoint inhibitors.
机构信息
Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York.
Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.
出版信息
Neuro Oncol. 2019 Dec 17;21(12):1578-1586. doi: 10.1093/neuonc/noz141.
BACKGROUND
Melanoma brain metastases historically portend a dismal prognosis, but recent advances in immune checkpoint inhibitors (ICIs) have been associated with durable responses in some patients. There are no validated imaging biomarkers associated with outcomes in patients with melanoma brain metastases receiving ICIs. We hypothesized that radiomic analysis of magnetic resonance images (MRIs) could identify higher-order features associated with survival.
METHODS
Between 2010 and 2019, we retrospectively reviewed patients with melanoma brain metastases who received ICI. After volumes of interest were drawn, several texture and edge descriptors, including first-order, Haralick, Gabor, Sobel, and Laplacian of Gaussian (LoG) features were extracted. Progression was determined using Response Assessment in Neuro-Oncology Brain Metastases. Univariate Cox regression was performed for each radiomic feature with adjustment for multiple comparisons followed by Lasso regression and multivariate analysis.
RESULTS
Eighty-eight patients with 196 total brain metastases were identified. Median age was 63.5 years (range, 19-91 y). Ninety percent of patients had Eastern Cooperative Oncology Group performance status of 0 or 1 and 35% had elevated lactate dehydrogenase. Sixty-three patients (72%) received ipilimumab, 11 patients (13%) received programmed cell death protein 1 blockade, and 14 patients (16%) received nivolumab plus ipilimumab. Multiple features were associated with increased overall survival (OS), and LoG edge features best explained the variation in outcome (hazard ratio: 0.68, P = 0.001). In multivariate analysis, a similar trend with LoG was seen, but no longer significant with OS. Findings were confirmed in an independent cohort.
CONCLUSION
Higher-order MRI radiomic features in patients with melanoma brain metastases receiving ICI were associated with a trend toward improved OS.
背景
黑色素瘤脑转移患者的预后历来较差，但近年来免疫检查点抑制剂（ICI）的进展已与部分患者的持久反应相关。目前尚无与接受 ICI 的黑色素瘤脑转移患者结局相关的经验证的影像学生物标志物。我们假设磁共振成像（MRI）的放射组学分析可以识别与生存相关的更高阶特征。
方法
我们回顾性分析了 2010 年至 2019 年间接受 ICI 治疗的黑色素瘤脑转移患者。在确定感兴趣区域后，提取了包括一阶、Haralick、Gabor、Sobel 和拉普拉斯高斯（LoG）特征在内的几种纹理和边缘描述符。使用神经肿瘤学脑转移反应评估标准来确定进展。对每个放射组学特征进行单变量 Cox 回归分析，并进行多次比较调整，然后进行 Lasso 回归和多变量分析。
结果
共纳入 88 例患者，共计 196 个脑转移灶。中位年龄为 63.5 岁（范围 19-91 岁）。90%的患者的东部肿瘤协作组体能状态为 0 或 1，35%的患者乳酸脱氢酶升高。63 例（72%）患者接受伊匹单抗治疗，11 例（13%）患者接受程序性死亡蛋白 1 阻滞剂治疗，14 例（16%）患者接受纳武单抗联合伊匹单抗治疗。多个特征与总生存期（OS）增加相关，LoG 边缘特征可最佳解释结局的变化（风险比：0.68，P = 0.001）。在多变量分析中，LoG 也显示出类似的趋势，但与 OS 不再显著相关。这些发现在一个独立的队列中得到了证实。
结论
接受 ICI 的黑色素瘤脑转移患者的高阶 MRI 放射组学特征与 OS 改善的趋势相关。
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