Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou,, Fujian Province, China.
Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian Province, China.
Ann Surg Oncol. 2022 Aug;29(8):5022-5033. doi: 10.1245/s10434-022-11499-z. Epub 2022 Mar 16.
The tumor immunosuppressive microenvironment can influence treatment response and outcomes. A previously validated immunosuppression scoring system (ISS) assesses multiple immune checkpoints in gastric cancer (GC) using tissue-based assays. We aimed to develop a radiological signature for non-invasive assessment of ISS and treatment outcomes.
A total of 642 patients with resectable GC from three centers were divided into four cohorts. Radiomic features were extracted from portal venous-phase CT images of GC. A radiomic signature for predicting ISS (RISS) was constructed using the least absolute shrinkage and selection operator (LASSO) regression method. Moreover, we investigated the value of the RISS in predicting survival and chemotherapy response.
The RISS, which consisted of 10 selected features, showed good discrimination of immunosuppressive status in three independent cohorts (area under the curve = 0.840, 0.809, and 0.843, respectively). Multivariate analysis revealed that the RISS was an independent prognostic factor for both disease-free survival (DFS) and overall survival (OS) in all cohorts (all p < 0.05). Further analysis revealed that stage II and III GC patients with low RISS exhibited a favorable response to adjuvant chemotherapy (OS: hazard ratio [HR] 0.407, 95% confidence interval [CI] 0.284-0.584); DFS: HR 0.395, 95% CI 0.275-0.568). Furthermore, the RISS could predict prognosis and select stage II and III GC patients who could benefit from adjuvant chemotherapy independent of microsatellite instability status and Epstein-Barr virus status.
The new, non-invasive radiomic signature could effectively predict the immunosuppressive status and prognosis of GC. Moreover, the RISS could help identify stage II and III GC patients most likely to benefit from adjuvant chemotherapy and avoid overtreatment.
肿瘤免疫抑制微环境会影响治疗反应和结局。先前验证的免疫抑制评分系统（ISS）使用基于组织的检测方法评估胃癌（GC）中的多种免疫检查点。我们旨在开发一种用于非侵入性评估 ISS 和治疗结果的放射组学特征。
共有来自三个中心的 642 名可切除 GC 患者被分为四组。从 GC 的门静脉期 CT 图像中提取放射组学特征。使用最小绝对值收缩和选择算子（LASSO）回归方法构建用于预测 ISS 的放射组学特征（RISS）。此外，我们还研究了 RISS 在预测生存和化疗反应中的价值。
由 10 个选定特征组成的 RISS 在三个独立队列中均能很好地区分免疫抑制状态（曲线下面积分别为 0.840、0.809 和 0.843）。多变量分析显示，RISS 是所有队列中无病生存（DFS）和总生存（OS）的独立预后因素（均 P<0.05）。进一步分析表明，低 RISS 的 II 期和 III 期 GC 患者对辅助化疗有良好的反应（OS：风险比 [HR] 0.407，95%置信区间 [CI] 0.284-0.584；DFS：HR 0.395，95% CI 0.275-0.568）。此外，RISS 可以预测预后，并选择可能从辅助化疗中获益的 II 期和 III 期 GC 患者，而与微卫星不稳定性状态和 EBV 状态无关。
新的非侵入性放射组学特征可有效预测 GC 的免疫抑制状态和预后。此外，RISS 可以帮助确定最有可能从辅助化疗中获益并避免过度治疗的 II 期和 III 期 GC 患者。
