Abstract
Purpose. To determine whether the radiomic features of 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) contribute to prognosis prediction in primary gastric diffuse large B-cell lymphoma (PG-DLBCL) patients. Methods. This retrospective study included 35 PG-DLBCL patients who underwent PET/CT scans at West China Hospital before curative treatment. The volume of interest (VOI) was drawn around the tumor, and radiomic analysis of the PET and CT images, within the same VOI, was conducted. The metabolic and textural features of PET and CT images were evaluated. Correlations of the extracted features with the overall survival (OS) and progression-free survival (PFS) were evaluated. Univariate and multivariate analyses were conducted to assess the prognostic value of the radiomic parameters. Results. In the univariate model, many of the textural features, including kurtosis and volume, extracted from the PET and CT datasets were significantly associated with survival (5 for OS and 7 for PFS (PET); 7 for OS and 14 for PFS (CT)). Multivariate analysis identified kurtosis (hazard ratio (HR): 28.685, 95% confidence interval (CI): 2.067–398.152, p=0.012), metabolic tumor volume (MTV) (HR: 26.152, 95% CI: 2.089–327.392, p=0.011), and gray-level nonuniformity (GLNU) (HR: 14.642, 95% CI: 2.661–80.549, p=0.002) in PET and sphericity (HR: 11.390, 95% CI: 1.360–95.371, p=0.025) and kurtosis (HR: 11.791, 95% CI: 1.583–87.808, p=0.016), gray-level nonuniformity (GLNU) (HR: 6.934, 95% CI: 1.069–44.981, p=0.042), and high gray-level zone emphasis (HGZE) (HR: 9.805, 95% CI: 1.359–70.747, p=0.024) in CT as independent prognostic factors. Conclusion. 18F-FDG PET/CT radiomic features are potentially useful for survival prediction in PG-DLBCL patients. However, studies with larger cohorts are needed to confirm the clinical prognostication of these parameters.
Highlights
Contrast Media & Molecular Imaging have tested the use of metabolic intensity for predicting the progression-free survival (PFS) and overall survival (OS) of patients with lymphoma [6,7,8]
No previous study has associated radiomic signatures from either features of 18F- uorodeoxyglucose (FDG)-PET or CT with the outcome of patients with PG-di use large B-cell lymphoma (DLBCL). erefore, our study aims to investigate the prognostic ability of the radiomic features of 18F-FDG PET and the low-dose CT component of pretreatment PET-CT in patients with PGDLBCL
Among 128 PG-DLBCL patients, 93 were excluded due to meeting the exclusion criteria. e study cohort comprised 35 patients with a median age of 58 years, including men (48.6%) and women (51.4%). e death occurred in five patients within an average time of 8.2 months from the baseline positron emission tomography/computed tomography (PET/CT), and relapse or progression of disease occurred in seven patients within an average time of 21.7 months. e median OS and PFS were 23.9 and 23.6 months, respectively
Summary
Informed consent was waived because this was a retrospective study In this retrospective singlecenter investigation, the following inclusion/exclusion criteria were applied to select patients from the institutional database. E inclusion criteria were (a) patients with biopsy-proven PG-DLBCL and (b) those who underwent an FDG-PET/CT scan at baseline at our institution between December 2012 and December 2017. Clinical information (including age, sex, lactate dehydrogenase, B symptoms, Ann Arbor staging, and IPI score), PET-CT images, and follow-up data were acquired. E VOI in the primary tumor lesion was semiautomatically defined on PET images with a threshold of 40% of the SUVmax, with segmentation corrections performed manually by consensus by two nuclear medicine-certified physicians. Intensity discretization for CT images was performed with the number of gray levels of 400
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