Abstract
ObjectiveTo assess the performance of pretreatment 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) radiomics features for predicting EGFR mutation status in patients with non-small cell lung cancer (NSCLC).Patients and MethodsWe enrolled total 173 patients with histologically proven NSCLC who underwent preoperative 18F-FDG PET/CT. Tumor tissues of all patients were tested for EGFR mutation status. A PET/CT radiomics prediction model was established through multi-step feature selection. The predictive performances of radiomics model, clinical features and conventional PET-derived semi-quantitative parameters were compared using receiver operating curves (ROCs) analysis.ResultsFour CT and two PET radiomics features were finally selected to build the PET/CT radiomics model. Compared with area under the ROC curve (AUC) equal to 0.664, 0.683 and 0.662 for clinical features, maximum standardized uptake values (SUVmax) and total lesion glycolysis (TLG), the PET/CT radiomics model showed better performance to discriminate between EGFR positive and negative mutations with the AUC of 0.769 and the accuracy of 67.06% after 10-fold cross-validation. The combined model, based on the PET/CT radiomics and clinical feature (gender) further improved the AUC to 0.827 and the accuracy to 75.29%. Only one PET radiomics feature demonstrated significant but low predictive ability (AUC = 0.661) for differentiating 19 Del from 21 L858R mutation subtypes.ConclusionsEGFR mutations status in patients with NSCLC could be well predicted by the combined model based on 18F-FDG PET/CT radiomics and clinical feature, providing an alternative useful method for the selection of targeted therapy.
Highlights
Lung cancer is the leading cause of cancer-related death in the world [1]
There was no statistical difference in age between patients with or without Epidermal growth factor receptor (EGFR) mutations. 39% (68/173) and 61% (105/ 173) of patients were stage I/II and stage III/IV, respectively
EGFR-tyrosine kinase inhibitor (TKI) is an important treatment for patients with Non-small cell lung cancer (NSCLC)
Summary
Lung cancer is the leading cause of cancer-related death in the world [1]. Epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI) has become a first-line drug in the treatment of NSCLC. Because the efficacy of TKI therapy is closely related to EGFR mutation status, identification of mutation status before the administration of TKI is crucial in achieving the best curative effect. Exon 19 deletion (19 del) and exon 21 L858R point mutation (21 L858R),the most common mutation subtypes of EGFR [3], demonstrate different clinical outcomes in patients with NSCLC after TKI treatment [4, 5]. Focal tissue testing may sometimes be limited by invasive procedures or tissue samples that are not readily available [7], causing patients to lose potential opportunities for EGFR-TKI treatment
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