18F-2-氟-2-脱氧葡萄糖PET/计算机断层扫描影像组学在一线表皮生长因子受体酪氨酸激酶抑制剂治疗的晚期肺腺癌患者表皮生长因子受体突变亚型预测及无进展生存期方面的价值
The value of 18F-2-fluoro-2-deoxyglucose PET/computed tomography radiomics in epidermal growth factor receptor mutation subtypes prediction and progression-free survival in advanced lung adenocarcinoma patients with first-line epidermal growth factor receptor tyrosine kinase inhibitors therapy.
作者信息
Liu Yi, Peng Yushi, Chen Fangansheng, Yao Rui, Wang Ling, Tang Kun
机构信息
Department of Pulmonary and Critical Care Medicine.
Department of Nuclear Medicine, The First Affiliated Hospital of Wenzhou Medical University.
出版信息
Nucl Med Commun. 2025 Jul 21. doi: 10.1097/MNM.0000000000002032.
OBJECTIVE
Epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) improve survival of EGFR-mutated lung adenocarcinoma (LUAD); however, outcomes vary with genetic subtypes and tumor heterogeneity in late-stage. We aimed to construct pretreatment 18F-2-fluoro-2-deoxyglucose PET/computed tomography (18F-FDG PET/CT) radiomics models for EGFR-subtype prediction and prognosis in first-line TKIs-treated patients.
METHODS
We retrospectively analyzed 131 EGFR-mutated advanced LUAD patients from 2017 to 2024: 72 exon 19 deletion (19Del) and 59 exon 21 L858R (21L858R) mutations. After feature selection, support vector machine models: PET, CT, PET-CT, and clinical PET-CT combined models were built. Performance was evaluated by areas under the receiver operating characteristic curve (AUC), calibration curves, and decision curve analysis (DCA). Model-derived radscore was used to explore progression-free survival (PFS) in first-line EGFR-TKIs-treated patients. Multivariate Cox regression was conducted to identify independent factors.
RESULTS
The clinical PET/CT combined model achieved AUCs of 0.854 [95% confidence interval (CI): 0.776-0.932] and 0.785 (95% CI: 0.639-0.932) in training and test sets. The calibration curves showed good agreement, and the DCA confirmed clinical utility. Among 125 successfully followed patients, 21L858R mutation patients showed poorer median PFS (P = 0.008) compared to 19Del mutation. High radscore [hazard ratio (HR): 0.57, 95% CI: 0.34-0.94, P = 0.029], third-generation TKI therapy (HR: 0.45, 95% CI: 0.27-0.73, P = 0.001), and high maximum standardized uptake value (HR: 1.67, 95% CI: 1.03-2.69, P = 0.036) were independent factors of PFS.
CONCLUSION
Integrating 18F-FDG PET/CT radiomics with clinical data precisely identifies EGFR mutation subtypes and guides initial TKI monotherapy in advanced LUAD.
目的
表皮生长因子受体酪氨酸激酶抑制剂（EGFR-TKIs）可提高EGFR突变型肺腺癌（LUAD）患者的生存率；然而，晚期患者的治疗结果因基因亚型和肿瘤异质性而异。我们旨在构建治疗前18F-2-氟-2-脱氧葡萄糖PET/计算机断层扫描（18F-FDG PET/CT）影像学模型，用于预测一线TKIs治疗患者的EGFR亚型及预后。
方法
我们回顾性分析了2017年至2024年的131例EGFR突变的晚期LUAD患者：72例为外显子19缺失（19Del），59例为外显子21 L858R（21L858R）突变。经过特征选择后，构建了支持向量机模型：PET、CT、PET-CT和临床PET-CT联合模型。通过受试者操作特征曲线（AUC）下面积、校准曲线和决策曲线分析（DCA）评估模型性能。模型衍生的radscore用于探索一线EGFR-TKIs治疗患者的无进展生存期（PFS）。进行多变量Cox回归以确定独立因素。
结果
临床PET/CT联合模型在训练集和测试集中的AUC分别为0.854 [95%置信区间（CI）：0.776-0.932]和0.785（95% CI：0.639-0.932）。校准曲线显示出良好的一致性，DCA证实了其临床实用性。在125例成功随访的患者中，21L858R突变患者的中位PFS较19Del突变患者差（P = 0.008）。高radscore [风险比（HR）：0.57，95% CI：0.34-0.94，P = 0.029]、第三代TKI治疗（HR：0.45，95% CI：0.27-0.73，P = 0.001）和高最大标准化摄取值（HR：1.67，95% CI：1.03-2.69，P = 0.036）是PFS的独立因素。
结论
将18F-FDG PET/CT影像学与临床数据相结合，可精确识别EGFR突变亚型，并指导晚期LUAD的初始TKI单药治疗。
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