Crimì Filippo, Turatto Francesca, D'Alessandro Carlo, Sussan Giovanni, Iacobone Maurizio, Torresan Francesca, Tizianel Irene, Campi Cristina, Quaia Emilio, Caccese Mario, Ceccato Filippo
Department of Medicine-DIMED, University of Padova, Padova, Italy.
Institute of Radiology, University-Hospital of Padova, Padova, Italy.
J Endocrinol Invest. 2025 Mar;48(3):711-720. doi: 10.1007/s40618-024-02476-2. Epub 2024 Oct 9.
The adrenocortical carcinoma (ACC) is a rare and highly aggressive malignancy originating from the adrenal cortex. These patients usually undergo chemotherapy with etoposide, doxorubicin, cisplatin and mitotane (EDP-M) in case of locally advanced or metastatic ACC. Computed tomography (CT) radiomics showed to be useful in adrenal pathologies. The study aimed to analyze the association between response to EDP-M treatment and CT textural features at diagnosis in patients with locally advanced or metastatic ACCs.
We enrolled 17 patients with advanced or metastatic ACC who underwent CT before and after EDP-M therapy. The response to treatment was evaluated according to RECIST 1.1, Choi, and volumetric criteria. Based on the aforementioned criteria, the patients were classified as responders and not responders. Textural features were extracted from the biggest lesion in contrast-enhanced CT images with LifeX software. ROC curves were drawn for the variables that were significantly different (p < 0.05) between the two groups.
Long-run high grey level emphasis (LRHGLE_GLRLM) and histogram kurtosis were significantly different between responder and not responder groups (p = 0.04) and the multivariate ROC curve combining the two features showed a very good AUC (0.900; 95%IC: 0.724-1.000) in discriminating responders from not responders. More heterogeneous tissue texture of initial staging CT in locally advanced or metastatic ACC could predict the positive response to EDP-M treatment.
Adrenal texture is able to predict the response to EDP-M therapy in patients with advanced ACC.
肾上腺皮质癌（ACC）是一种罕见且侵袭性很强的源自肾上腺皮质的恶性肿瘤。对于局部晚期或转移性ACC患者，通常采用依托泊苷、阿霉素、顺铂和米托坦（EDP-M）进行化疗。计算机断层扫描（CT）影像组学已被证明在肾上腺疾病中有用。本研究旨在分析局部晚期或转移性ACC患者诊断时CT纹理特征与EDP-M治疗反应之间的关联。
我们纳入了17例晚期或转移性ACC患者，这些患者在EDP-M治疗前后均接受了CT检查。根据实体瘤疗效评价标准（RECIST）1.1、Choi标准和容积标准评估治疗反应。根据上述标准，将患者分为反应者和无反应者。使用LifeX软件从增强CT图像中的最大病灶提取纹理特征。为两组之间有显著差异（p < 0.05）的变量绘制受试者工作特征（ROC）曲线。
反应者组和无反应者组之间的长期高灰度强调（LRHGLE_GLRLM）和直方图峰度有显著差异（p = 0.04），结合这两个特征的多变量ROC曲线在区分反应者和无反应者方面显示出非常好的曲线下面积（AUC）（0.900；95%置信区间：0.724 - 1.000）。局部晚期或转移性ACC初始分期CT中组织纹理越不均匀，越能预测对EDP-M治疗的阳性反应。
肾上腺纹理能够预测晚期ACC患者对EDP-M治疗的反应。
