Cheng Nai-Ming, Hsieh Cheng-En, Fang Yu-Hua Dean, Liao Chun-Ta, Ng Shu-Hang, Wang Hung-Ming, Chou Wen-Chi, Lin Chien-Yu, Yen Tzu-Chen
Department of Nuclear Medicine and Molecular Imaging Center, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.
Department of Nuclear Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan.
EJNMMI Res. 2020 Jul 6;10(1):74. doi: 10.1186/s13550-020-00631-3.
The aim of this study was to develop and validate a prognostic model incorporating [F]FDG PET/CT radiomics for patients of minor salivary gland carcinoma (MSGC).
We retrospectively reviewed the pretreatment [F]FDG PET/CT images of 75 MSGC patients treated with curative intent. Using a 1.5:1 ratio, the patients were randomly divided into a training and validation group. The main outcome measurements were overall survival (OS) and relapse-free survival (RFS). All of the patients were followed up for at least 30 months or until death. Following segmentation of tumors and lymph nodes on PET images, radiomic features were extracted. The prognostic significance of PET radiomics and clinical parameters in the training group was examined using receiver operating characteristic curve analysis. Variables showing a significant impact on OS and RFS were entered into multivariable Cox regression models. Recursive partitioning analysis was subsequently implemented to devise a prognostic index, whose performance was examined in the validation group. Finally, the performance of the index was compared with clinical variables in the entire cohort and nomograms for surgically treated cases.
The training and validation groups consisted of 45 and 30 patients, respectively. The median follow-up time in the entire cohort was 59.5 months. Eighteen relapse, 19 dead, and thirteen relapse, eight dead events were found in the training and validation cohorts, respectively. In the training group, two factors were identified as independently associated with poor OS, i.e., (1) tumors with both high maximum standardized uptake value (SUV) and discretized intensity entropy and (2) poor performance status or N2c-N3 stage. A prognostic model based on the above factors was devised and showed significant higher concordance index (C-index) for OS than those of AJCC stage and high-risk histology (C-index: 0.83 vs. 0.65, P = 0.005; 0.83 vs. 0.54, P < 0.001, respectively). This index also demonstrated superior performance than nomogram for OS (C-index: 0.88 vs. 0.70, P = 0.017) and that for RFS (C-index: 0.87 vs. 0.72, P = 0.004).
We devised a novel prognostic model that incorporates [F]FDG PET/CT radiomics and may help refine outcome prediction in patients with MSGC.
本研究旨在开发并验证一种纳入[F]FDG PET/CT影像组学的小涎腺癌（MSGC）患者预后模型。
我们回顾性分析了75例接受根治性治疗的MSGC患者的治疗前[F]FDG PET/CT图像。按照1.5:1的比例，将患者随机分为训练组和验证组。主要观察指标为总生存期（OS）和无复发生存期（RFS）。所有患者均随访至少30个月或直至死亡。在PET图像上对肿瘤和淋巴结进行分割后，提取影像组学特征。使用受试者工作特征曲线分析来检验训练组中PET影像组学和临床参数的预后意义。将对OS和RFS有显著影响的变量纳入多变量Cox回归模型。随后进行递归划分分析以设计一个预后指数，并在验证组中检验其性能。最后，在整个队列中将该指数的性能与临床变量进行比较，并为手术治疗病例绘制列线图。
训练组和验证组分别有45例和30例患者。整个队列的中位随访时间为59.5个月。训练组和验证组分别发现18例复发、1... 展开 19例死亡，以及13例复发、8例死亡事件。在训练组中，有两个因素被确定与不良OS独立相关，即：（1）最大标准化摄取值（SUV）高且离散强度熵高的肿瘤，以及（2）身体状况差或N2c - N3期。基于上述因素设计了一个预后模型，该模型显示出比AJCC分期和高危组织学更高的OS一致性指数（C指数）（C指数：0... 展开 83对0.65，P = 0.005；0.83对0.54，P < 0.001）。该指数在OS方面也显示出比列线图更好的性能（C指数: 0.88对0.70，P = 0.017）以及在RFS方面（C指数: 0.87对0.72，P = 0.004）。
我们设计了一种纳入[F]FDG PET/CT影像组学的新型预后模型，可能有助于优化MSGC患者的预后预测。
