Radiomics analysis of pre-treatment [18F]FDG PET/CT for patients with metastatic colorectal cancer undergoing palliative systemic treatment

Abstract

BackgroundThe aim of this study was to assess radiomics features on pre-treatment [18F]FDG positron emission tomography (PET) as potential biomarkers for response and survival in patients with metastatic colorectal cancer (mCRC).MethodsPatients with mCRC underwent [18F]FDG PET/computed tomography (CT) prior to first- or third-line palliative systemic treatment. Tumour lesions were semiautomatically delineated and standard uptake value (SUV), metabolically active tumour volume (MATV), total lesion glycolysis (TLG), entropy, area under the curve of the cumulative SUV-volume histogram (AUC-CSH), compactness and sphericity were obtained.ResultsLesions of 47 patients receiving third-line systemic treatment had higher SUVmax, SUVpeak, SUVmean, MATV and TLG, and lower AUC-CSH, compactness and sphericity compared to 52 patients receiving first-line systemic treatment. Therefore, first- and third-line groups were evaluated separately. In the first-line group, anatomical changes on CT correlated negatively with TLG (ρ = 0.31) and MATV (ρ = 0.36), and positively with compactness (ρ = −0.27) and sphericity (ρ = −0.27). Patients without benefit had higher mean entropy (p = 0.021). Progression-free survival (PFS) and overall survival (OS) were worse with a decreased mean AUC [hazard ratio (HR) 0.86, HR 0.77] and increase in mean MATV (HR 1.15, HR 1.22), sum MATV (HR 1.14, HR 1.19), mean TLG (HR 1.16, HR 1.22) and sum TLG (HT1.12, HR1.18). In the third-line group, AUC-CSH correlated negatively with anatomical change (ρ = 0.21). PFS and OS were worse with an increased mean MATV (HR 1.27, HR 1.68), sum MATV (HR 1.35, HR 2.04), mean TLG (HR 1.29, HR 1.52) and sum TLG (HT 1.27, HR 1.80). SUVmax and SUVpeak negatively correlated with OS (HR 1.19, HR 1.21). Cluster analysis of the 10 radiomics features demonstrated no complementary value in identifying aggressively growing lesions or patients with impaired survival.ConclusionWe demonstrated an association between improved clinical outcome and pre-treatment low tumour volume and heterogeneity as well as high sphericity on [18F]FDG PET. Future PET imaging research should include radiomics features that incorporate tumour volume and heterogeneity when correlating PET data with clinical outcome.Electronic supplementary materialThe online version of this article (10.1007/s00259-018-4100-6) contains supplementary material, which is available to authorized users.

Radiomics of Liver Metastases: A Systematic Review

“…Most papers ( n = 28) described retrospective analyses, while four reported planned secondary analyses of prospectively acquired data [ 32 , 33 , 34 , 35 ]. Nineteen authors analyzed computed tomography (CT) [ 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 ], eight magnetic resonance imaging (MRI) [ 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 ], three positron-emission tomography (PET)/CT [ 59 , 60 , 61 ], and two multiple imaging modalities (CT and MRI; PET and MRI, respectively) [ 62 , 63 ]. Various software applications were used for texture analysis, with these being custom-made in a large proportion of cases ( n = 10).…”

“…Ten studies analyzed radiomic features’ ability to predict the outcome of patients with colorectal LM [ 32 , 33 , 38 , 40 , 43 , 46 , 47 , 59 , 61 , 62 ]. Four included training and validation datasets [ 33 , 37 , 40 , 46 ].…”

“…Four included training and validation datasets [ 33 , 37 , 40 , 46 ]. The endpoint was overall survival (OS) in nine studies [ 32 , 33 , 38 , 40 , 43 , 46 , 47 , 59 , 61 ], progression-free survival (PFS) in four [ 46 , 59 , 61 , 62 ], hepatic PFS in one [ 47 ], and event-free survival in one [ 59 ]. In six papers, patients underwent chemotherapy [ 32 , 33 , 40 , 43 , 46 , 61 ], in two, liver surgery [ 47 , 62 ], and in two, either chemotherapy or surgery [ 38 , 59 ].…”

“…The endpoint was overall survival (OS) in nine studies [ 32 , 33 , 38 , 40 , 43 , 46 , 47 , 59 , 61 ], progression-free survival (PFS) in four [ 46 , 59 , 61 , 62 ], hepatic PFS in one [ 47 ], and event-free survival in one [ 59 ]. In six papers, patients underwent chemotherapy [ 32 , 33 , 40 , 43 , 46 , 61 ], in two, liver surgery [ 47 , 62 ], and in two, either chemotherapy or surgery [ 38 , 59 ]. Six studies analyzed imaging modalities before treatment [ 38 , 43 , 47 , 59 , 61 , 62 ], while four performed comparative analyses of imaging modalities before and after chemotherapy [ 32 , 33 , 40 , 46 ].…”

Radiomics Features of 18F-fluorodeoxyglucose Positron-Emission Tomography as a Novel Prognostic Signature in Colorectal Cancer

“…Moreover, we applied standardization of features as a preprocessing step before entering the data into the LASSO COX model, following a method that has already been adopted for radiomics analysis in patients with breast or gastric cancer [28,30]. However, most previous studies of PETderived radiomics analysis in patients with CRC did not use standardization as a preprocessing step [17][18][19]43]. The effect of this preprocessing needs to be investigated with more clinical data.…”