Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
Department of Imaging, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA.
Oncologist. 2022 May 6;27(5):389-397. doi: 10.1093/oncolo/oyac034.
The treatment responses of immune checkpoint inhibitors in metastatic renal cell carcinoma (mRCC) vary, requiring reliable prognostic biomarkers. We assessed the prognostic ability of computed tomography (CT) texture analysis in patients with mRCC treated with programmed death receptor-1 (PD-1)/programmed death ligand-1 (PD-L1) inhibitors.
Sixty-eight patients with mRCC treated with PD-1/PD-L1 inhibitors between 2012 and 2019 were revaluated. Using baseline and first follow-up CT, baseline and follow-up texture models were developed to predict overall survival (OS) and progression-free survival (PFS) using least absolute shrinkage and selection operator Cox-proportional hazards analysis. Patients were divided into high-risk or low-risk group, and the survival difference was assessed using Kaplan-Meier and log-rank test. Multivariable Cox models were constructed by including only the clinical variables (clinical models) and by combining the clinical variables and the texture models (combined clinical-texture models), and their predictive performance was evaluated using Harrell's C-index.
The baseline texture models distinguished longer- and shorter-term survivors for both OS (median, 60.1 vs. 17.0 months; P = .048) and PFS (5.2 vs. 2.8 months; P = .003). The follow-up texture models distinguished longer- and shorter-term overall survivors (40.3 vs. 15.2 months; P = .008) but not for PFS (5.0 vs. 3.6 months; P = .25). The combined clinical-texture model outperformed the clinical model in both predicting the OS (C-index, 0.70 vs. 0.63; P = .03) and PFS (C-index, 0.63 vs. 0.55; P = .04).
CT texture analysis performed at baseline and early after starting PD-1/PD-L1 inhibitors is associated with clinical outcomes of patients with mRCC.
免疫检查点抑制剂在转移性肾细胞癌（mRCC）中的治疗反应各不相同，因此需要可靠的预后生物标志物。我们评估了 CT 纹理分析在接受程序性死亡受体-1（PD-1）/程序性死亡配体-1（PD-L1）抑制剂治疗的 mRCC 患者中的预后能力。
回顾性分析 2012 年至 2019 年间接受 PD-1/PD-L1 抑制剂治疗的 68 例 mRCC 患者。使用基线和首次随访 CT，采用最小绝对收缩和选择算子 Cox 比例风险分析，建立基线和随访纹理模型，预测总生存期（OS）和无进展生存期（PFS）。将患者分为高危或低危组，采用 Kaplan-Meier 和对数秩检验评估生存差异。通过仅包含临床变量（临床模型）和同时包含临床变量和纹理模型（联合临床-纹理模型）构建多变量 Cox 模型，并使用 Harrell's C-index 评估其预测性能。
基线纹理模型区分了 OS（中位，60.1 个月与 17.0 个月；P =.048）和 PFS（5.2 个月与 2.8 个月；P =.003）的长生存期和短生存期患者。随访纹理模型区分了 OS 的长生存期和短生存期患者（40.3 个月与 15.2 个月；P =.008），但不能区分 PFS（5.0 个月与 3.6 个月；P =.25）。联合临床-纹理模型在预测 OS（C-index，0.70 与 0.63；P =.03）和 PFS（C-index，0.63 与 0.55；P =.04）方面均优于临床模型。
在开始接受 PD-1/PD-L1 抑制剂治疗后基线和早期进行 CT 纹理分析与 mRCC 患者的临床结局相关。
