Kim Chu Hyun, Park Hyunjin, Lee Ho Yun, Ahn Joong Hyun, Lee Seung Hak, Sohn Insuk, Choi Joon Young, Kim Hong Kwan
Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea.
School of Electronic and Electrical Engineering, Sungkyunkwan University, Suwon 16419, Korea.
Cancers (Basel). 2020 Nov 28;12(12):3564. doi: 10.3390/cancers12123564.
Although a substantial decrease in 2-[fluorine-18]fluoro-2-deoxy-d-glucose (FDG) uptake on positron emission tomography-computed tomography (PET-CT) indicates a promising metabolic response to treatment, predicting the pathologic status of lymph nodes (LN) remains challenging. We investigated the potential of a CT radiomics approach to predict the pathologic complete response of LNs showing residual uptake after neoadjuvant concurrent chemoradiotherapy (NeoCCRT) in patients with non-small cell lung cancer (NSCLC). Two hundred and thirty-seven patients who underwent NeoCCRT for stage IIIa NSCLC were included. Two hundred fifty-two CT radiomics features were extracted from LNs showing remaining positive FDG uptake upon restaging PET-CT. A multivariable logistic regression analysis of radiomics features and clinicopathologic characteristics was used to develop a prediction model. Of the 237 patients, 135 patients (185 nodes) met our inclusion criteria. Eighty-seven LNs were proven to be malignant (47.0%, 87/185). Upon multivariable analysis, metastatic LNs were significantly prevalent in females and patients with adenocarcinoma (odds ratio (OR) = 2.02, 95% confidence interval (CI) = 0.88-4.62 and OR = 0.39, 95% CI = 0.19-0.77 each). Metastatic LNs also had a larger maximal 3D diameter and higher cluster tendency (OR = 9.92, 95% CI = 3.15-31.17 and OR = 2.36, 95% CI = 1.22-4.55 each). The predictive model for metastasis showed a discrimination performance with an area under the receiver operating characteristic curve of 0.728 (95% CI = 0.654-0.801, value < 0.001). The radiomics approach allows for the noninvasive detection of metastases in LNs with residual FDG uptake after the treatment of NSCLC patients.
尽管正电子发射断层扫描-计算机断层扫描（PET-CT）上2-[氟-18]氟-2-脱氧-d-葡萄糖（FDG）摄取的显著降低表明对治疗有良好的代谢反应，但预测淋巴结（LN）的病理状态仍然具有挑战性。我们研究了CT放射组学方法在预测非小细胞肺癌（NSCLC）患者新辅助同步放化疗（NeoCCRT）后显示残留摄取的LN病理完全缓解方面的潜力。纳入了237例接受IIIa期NSCLC新辅助同步放化疗的患者。从在重新分期PET-CT上显示FDG摄取仍为阳性的LN中提取了252个CT放射组学特征。使用放射组学特征和临床病理特征的多变量逻辑回归分析来建立预测模型。在237例患者中，135例患者（185个淋巴结）符合我们的纳入标准。87个LN被证实为恶性（47.0%，87/185）。多变量分析显示，转移性LN在女性和腺癌患者中显著更常见（优势比（OR）分别为2.02，95%置信区间（CI）=0.88-4.62和OR=0.39，95%CI=0.19-0.77）。转移性LN的最大三维直径也更大，聚集倾向更高（OR分别为9.92，95%CI=3.15-31.17和OR=2.36，95%CI=1.22-4.55）。转移预测模型的鉴别性能在受试者工作特征曲线下面积为0.728（95%CI=0.654-0.801，P值<0.001）。放射组学方法能够在NSCLC患者治疗后对FDG摄取残留的LN进行转移的无创检测。
