Computed Tomography-Based Texture Analysis as a Predictor of Survival in Patients with T-Cell Lymphomas

Abstract

Background: T-cell lymphomas constitute a heterogeneous group of hematological malignancies with global poor outcomes. Computed tomography (CT)-based texture analysis (CTTA) is a promising technique to predict the survival of these patients. Objectives: The present study aimed to investigate whether CTTA features on the pretreatment unenhanced CT scans of 18F-fluorodeoxyglucose positron emission tomography/CT (18F-FDG PET/CT) examination can predict the survival of patients with T-cell lymphomas. Patients and Methods: In this retrospective cohort study, patients with T-cell lymphomas, undergoing pretreatment 18F-FDG PET/CT scan during 2008 - 2019, were included, and their clinical and biological characteristics were collected. The mean gray value, entropy, kurtosis, skewness, and standard deviation were derived from the pixel distribution histogram before and after spatial filtration at different anatomic scales in up to five lesions per patient, indicating a high focal uptake on 18F-FDG PET scan. A Lasso-penalized Cox regression analysis was performed to identify independent predictors of overall survival (OS), progression-free survival at 24 months (PFS24), and PFS. Results: A total of 23 patients (7 females and 16 males; median age, 69 years; age range, 33 - 86 years) were included in this study. The CTTA was performed for 60 lesions. The median OS and PFS were 391 days (range, 10 - 3,463 days) and 268 days (range, 10 - 2,321 days), respectively. No CT texture parameter was associated with PFS or PFS24. The standard deviation at a coarse filter scale was independently associated with a poor OS (hazard ratio [HR] = 1.009, confidence interval [CI]: 1.0012 - 1.016, P = 0.02). A value above 143 was associated with a poor prognosis with a specificity of 81%. Conclusion: The pretreatment CTTA-derived tumor standard deviation at a coarse filter scale may be a predictive biomarker of OS in patients with T-cell lymphomas.