Abstract
Objective: To identify CT imaging biomarkers based on radiomic features for predicting brain metastases (BM) in patients with ALK-rearranged non-small cell lung cancer (NSCLC). Methods: NSCLC patients with pathologically confirmed ALK rearrangement from January 2014 to December 2020 in our hospital were enrolled retrospectively in this study. Finally, 77 patients were included according to the inclusion and exclusion criteria. Patients were divided into two groups: BM+ were those patients who were diagnosed with BM at baseline examination (n = 16) or within 1 year’s follow-up (n = 14), and BM− were those without BM followed up for at least 1 year (n = 47). Radiomic features were extracted from the pretreatment thoracic CT images. Sequential univariate logistic regression, LASSO regression, and backward stepwise logistic regression were used to select radiomic features and develop a BM-predicting model. Results: Five robust radiomic features were found to be independent predictors of BM. AUC for radiomics model was 0.828 (95% CI: 0.736–0.921), and when combined with clinical features, the AUC was increased (p = 0.017) to 0.909 (95% CI: 0.845–0.972). The individualized BM-predicting model incorporated with clinical features was visualized by the nomogram. Conclusion: Radiomic features extracted from pretreatment thoracic CT images have the potential to predict BM within 1 year after detection of the primary tumor in patients with ALK-rearranged NSCLC. The radiomics model incorporated with clinical features shows improved risk stratification for such patients.
Highlights
Lung cancer is the leading cause of cancer-related mortality worldwide
Patients were consecutively included according to the following inclusion criteria: (1) pathologically confirmed Non-small cell lung cancer (NSCLC) with Anaplastic lymphoma kinase (ALK) rearrangement; (2) available pretreatment thoracic CT images on picture archiving and communication system (PACS) performed less than 1 month before the pathologic sampling were collected; and (3) available brain MRI/PETCT/CT examination data at diagnosis of NSCLC and during follow-up to confirm the status of brain metastases (BMs)
A total of 112 radiomic features associated with BM (p < 0.05) were preliminarily identified by univariate logistic regression analysis (Supplementary Table S2)
Summary
Lung cancer is the leading cause of cancer-related mortality worldwide. Non-small cell lung cancer (NSCLC) accounts for 85% of all lung cancer incidence (Molina et al, 2008). 10%–20% of NSCLC patients have brain metastases (BMs) at initial presentation (Schuette, 2004; Khalifa et al, 2016). Another 25%–50% will develop BMs during the course of their disease (Langer and Mehta, 2005). It has been reported that 91% of BMs were diagnosed within 1 year of initial diagnosis of the primary tumor for patients with lung cancer (Schouten et al, 2002). For stage I–III NSCLC patients, the median time from treatment to onset of BMs as the first site of progression was 12 months (Bajard et al, 2004). NSCLC patients with BMs traditionally have a poor prognosis with a median survival of 7 months (Sperduto et al, 2010)
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