Abstract
BackgroundLymph node stage prior to treatment is strongly related to disease progression and poor prognosis in non-small cell lung cancer (NSCLC). However, few studies have investigated metabolic imaging features derived from pre-radiotherapy 18F-fluorodeoxyglucose (FDG) positron-emission tomography (PET) of metastatic hilar/mediastinal lymph nodes (LNs). We hypothesized that these would provide complementary prognostic information to FDG-PET descriptors to only the primary tumor (tumor).MethodsTwo independent cohorts of 262 and 50 node-positive NSCLC patients were used for model development and validation. Image features (i.e. Radiomics) including shape and size, first order statistics, texture, and intensity-volume histograms (IVH) (http://www.radiomics.io/) were evaluated by univariable Cox regression on the development cohort. Prognostic modeling was conducted with a 10-fold cross-validated least absolute shrinkage and selection operator (LASSO), automatically selecting amongst FDG-PET-Radiomics descriptors from (1) tumor, (2) LNs or (3) both structures. Performance was assessed with the concordance-index. Development data are publicly available at www.cancerdata.org and Dryad (doi:10.5061/dryad.752153b).ResultsCommon SUV descriptors (maximum, peak, and mean) were significantly related to overall survival when extracted from LNs, as were LN volume and tumor load (summed tumor and LNs’ volumes), though this was not true for either SUV metrics or tumor’s volume. Feature selection exclusively from imaging information based on FDG-PET-Radiomics, exhibited performances of (1) 0.53 –external 0.54, when derived from the tumor, (2) 0.62 –external 0.56 from LNs, and (3) 0.62 –external 0.59 from both structures, including at least one feature from each sub-category, except IVH.ConclusionCombining imaging information based on FDG-PET-Radiomics features from tumors and LNs is desirable to achieve a higher prognostic discriminative power for NSCLC.
Highlights
Non-small cell lung cancer (NSCLC) patients often present with hilar and/or mediastinal lymph node involvement at diagnosis or during the course of disease
Common SUV descriptors were significantly related to overall survival when extracted from lymph nodes (LNs), as were LN volume and tumor load, though this was not true for either SUV metrics or tumor’s volume
Combining imaging information based on FDG-positron-emission tomography (PET)-Radiomics features from tumors and LNs is desirable to achieve a higher prognostic discriminative power for non-small cell lung cancer (NSCLC)
Summary
Non-small cell lung cancer (NSCLC) patients often present with hilar and/or mediastinal lymph node involvement at diagnosis or during the course of disease. In this study we hypothesized that the local selection of more aggressive cancer cells in the metastatic hilar/mediastinal lymph nodes, being likely to determine prognosis, may provide an additional and valuable source of information to the primary tumor for NSCLC patients. Lymph node stage prior to treatment is strongly related to disease progression and poor prognosis in non-small cell lung cancer (NSCLC). Few studies have investigated metabolic imaging features derived from pre-radiotherapy 18F-fluorodeoxyglucose (FDG) positron-emission tomography (PET) of metastatic hilar/mediastinal lymph nodes (LNs). We hypothesized that these would provide complementary prognostic information to FDG-PET descriptors to only the primary tumor (tumor)
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
