Abstract
BackgroundImage texture analysis is a noninvasive technique for quantifying intratumoral heterogeneity, with derived texture features reported to be closely related to the treatment outcome of tumors. Gastric cancer is one of the most common tumors and the third leading cause of cancer-related deaths worldwide. Although trastuzumab is associated with a survival gain among patients with human epidermal growth factor receptor 2 (HER2)-positive advanced gastric cancer, optimal patient selection is challenging. The purpose of this study was to determine whether CT texture features of HER2-positive gastric cancer were related to the survival rate after trastuzumab treatment.Methods and FindingsPatients diagnosed with HER2-positive advanced gastric cancer from February 2007 to August 2014 were retrospectively selected. Using in-house built software, histogram features (kurtosis and skewness) and gray-level co-occurrence matrices (GLCM) features (angular second moment [ASM], contrast, entropy, variance, and correlation) were derived from the CT images of HER2-positive advanced gastric cancer in 26 patients. All the patients were followed up for more than 6 months, with no confirmed deaths. The patients were dichotomized into a good and poor survival group based on cutoff points of overall survival of 12 months. A receiver-operating characteristics (ROC) analysis was performed to test the ability of each texture parameter to identify the good survival group. Kaplan–Meier curves for patients above and below each threshold were constructed. Using a threshold of >265.8480 for contrast, >488.3150 for variance, and ≤0.1319×10−3. for correlation, all of the area under the ROC curves showed fair accuracy (>0.7). Kaplan–Meier analysis showed statistically significant survival difference between two groups according to optimal cutoff values of contrast, variance, correlation and ASM. However, as this study had a small number of patients, a further study with a larger population will be needed to validate the results.ConclusionsHeterogeneous texture features on CT images were associated with better survival in patients with HER2-positive advanced gastric cancer who received trastuzumab-based treatment. Therefore, texture analysis shows potential to be a clinically useful imaging biomarker providing additional prognostic information for patient selection.
Highlights
Intratumoral heterogeneity is a well-known feature of malignant tumors that can affect response rates and drug resistance to both cytotoxic and targeted chemotherapy [1, 2]
Heterogeneous texture features on CT images were associated with better survival in patients with human epidermal growth factor receptor 2 (HER2)-positive advanced gastric cancer who received trastuzumab-based treatment
Studies have shown that the results of image texture analysis were useful in the assessment and/or prediction of the tumor therapeutic response in various cancers, such as esophageal cancer, colorectal cancer, nonsmall cell lung cancer, and squamous cell carcinoma of the head and neck [4,5,6,7,8,9]
Summary
Intratumoral heterogeneity is a well-known feature of malignant tumors that can affect response rates and drug resistance to both cytotoxic and targeted chemotherapy [1, 2]. Several studies demonstrated an association between the response rate or prognosis after treatment and the texture features obtained from CT and MR images of patients with colorectal cancer [6, 7]. A randomized trial reported that the use of trastuzumab, a monoclonal antibody to human epidermal growth factor 2 (HER2) receptor to treat patients with HER2-positive gastric cancer conferred a significant survival [11]. Trastuzumab is associated with a survival gain among patients with human epidermal growth factor receptor 2 (HER2)-positive advanced gastric cancer, optimal patient selection is challenging. The purpose of this study was to determine whether CT texture features of HER2-positive gastric cancer were related to the survival rate after trastuzumab treatment
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