Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX.
Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX.
Clin Genitourin Cancer. 2024 Feb;22(1):33-37. doi: 10.1016/j.clgc.2023.07.004. Epub 2023 Jul 7.
Testicular germ cell tumors are the most common malignancy in young adult males. Patients with metastatic disease receive standard of care chemotherapy followed by retroperitoneal lymph node dissection for residual masses >1cm. However, there is a need for better preoperative tools to discern which patients will have persistent disease after chemotherapy given low rates of metastatic germ cell tumor after chemotherapy. The purpose of this study was to use radiomics to predict which patients would have viable germ cell tumor or teratoma after chemotherapy at time of retroperitoneal lymph node dissection.
Patients with nonseminomatous germ cell tumor undergoing postchemotherapy retroperitoneal lymph node dissection (PC-RPLND) between 2008 and 2019 were queried from our institutional database. Patients were included if prechemotherapy computed tomography (CT) scan and postchemotherapy imaging were available. Semiqualitative and quantitative features of residual masses and nodal regions of interest and radiomic feature extractions were performed by 2 board certified radiologists. Radiomic feature analysis was used to extract first order, shape, and second order statistics from each region of interest. Post-RPLND pathology was compared to the radiomic analysis using multiple t-tests.
45 patients underwent PC-RPLND at our institution, with the majority (28 patients) having stage III disease. 24 (53%) patients had teratoma on RPLND pathology, while 2 (4%) had viable germ cell tumor. After chemotherapy, 78%, 53%, and 33% of patients had cystic regions, fat stranding, and local infiltration present on imaging. After radiomic analysis, first order statistics mean, median, 90th percentile, and root mean squares were significant. Strong correlations were observed between these 4 features;a lower signal was associated with positive pathology at RPND.
Testicular radiomics is an emerging tool that may help predict persistent disease after chemotherapy.
睾丸生殖细胞肿瘤是年轻男性中最常见的恶性肿瘤。转移性疾病患者接受标准护理化疗，然后对残留肿块> 1cm 的腹膜后淋巴结进行解剖。然而，由于化疗后转移性生殖细胞瘤的比率较低，因此需要更好的术前工具来辨别哪些患者在化疗后仍会有疾病。本研究的目的是使用放射组学来预测在进行腹膜后淋巴结解剖时哪些患者在化疗后会有存活的生殖细胞瘤或畸胎瘤。
从我们的机构数据库中查询了 2008 年至 2019 年间接受化疗后腹膜后淋巴结解剖（PC-RPLND）的非精原细胞瘤生殖细胞肿瘤患者。如果有化疗前 CT 扫描和化疗后影像学检查，则纳入患者。由 2 名具有董事会认证的放射科医生对残留肿块和淋巴结区域的半定量和定量特征以及放射组学特征提取进行了分析。使用多个 t 检验将残留肿块和淋巴结区域的放射组学分析与术后病理进行比较。
我们机构有 45 名患者接受了 PC-RPLND，其中大多数（28 名）患有 III 期疾病。24 名（53%）患者在 RPLND 病理检查中发现畸胎瘤，而 2 名（4%）患者发现有存活的生殖细胞瘤。化疗后，78%、53%和 33%的患者在影像学上出现囊性区域、脂肪条纹和局部浸润。经过放射组学分析，一阶统计量均值、中位数、90 分位数和均方根是显著的。这 4 个特征之间存在很强的相关性；较低的信号与 RPND 的阳性病理相关。
睾丸放射组学是一种新兴的工具，可能有助于预测化疗后的持续性疾病。
