Department of Radiation Oncology, First Affiliated Hospital of Xiamen University, No. 55 Zhenhai Road, Siming District, Xiamen City, 361003, Fujian Province, China.
Department of Radiation Oncology, University of California Davis School of Medicine, Sacramento, CA, USA.
Sci Rep. 2020 Oct 19;10(1):17671. doi: 10.1038/s41598-020-74701-w.
Detection of patients with esophageal squamous cell carcinoma (ESCC) who do not benefit from standard chemoradiation (CRT) is an important medical need. Radiomics using 18-fluorodeoxyglucose (FDG) positron emission tomography (PET) is a promising approach. In this retrospective study of 184 patients with locally advanced ESCC. 152 patients from one center were grouped into a training cohort (n = 100) and an internal validation cohort (n = 52). External validation was performed with 32 patients treated at a second center. Primary endpoint was disease-free survival (DFS), secondary endpoints were overall survival (OS) and local control (LC). FDG-PET radiomics features were selected by Lasso-Cox regression analyses and a separate radiomics signature was calculated for each endpoint. In the training cohort radiomics signatures containing up to four PET derived features were able to identify non-responders in regard of all endpoints (DFS p < 0.001, LC p = 0.003, OS p = 0.001). After successful internal validation of the cutoff values generated by the training cohort for DFS (p = 0.025) and OS (p = 0.002), external validation using these cutoffs was successful for DFS (p = 0.002) but not for the other investigated endpoints. These results suggest that pre-treatment FDG-PET features may be useful to detect patients who do not respond to CRT and could benefit from alternative treatment.
检测不能从标准放化疗（CRT）中获益的食管鳞癌（ESCC）患者是一个重要的医疗需求。使用 18-氟脱氧葡萄糖（FDG）正电子发射断层扫描（PET）的放射组学是一种很有前途的方法。在这项对 184 例局部晚期 ESCC 患者的回顾性研究中，来自一个中心的 152 例患者被分为训练队列（n=100）和内部验证队列（n=52）。外部验证使用来自第二个中心的 32 例患者进行。主要终点是无病生存（DFS），次要终点是总生存（OS）和局部控制（LC）。FDG-PET 放射组学特征通过 Lasso-Cox 回归分析选择，并为每个终点计算单独的放射组学特征。在训练队列中，包含多达四个 PET 衍生特征的放射组学特征能够识别出所有终点的无反应者（DFS p<0.001，LC p=0.003，OS p=0.001）。在成功内部验证了训练队列生成的DFS（p=0.025）和 OS（p=0.002）的截止值后，使用这些截止值的外部验证在 DFS 方面是成功的（p=0.002），但在其他研究终点方面则不成功。这些结果表明，治疗前 FDG-PET 特征可能有助于检测不能从 CRT 中获益的患者，并可能从替代治疗中获益。
