Tumour heterogeneity in oesophageal cancer assessed by CT texture analysis: Preliminary evidence of an association with tumour metabolism, stage, and survival

Ganeshan, Balaji; Skogen, Karoline; Pressney, Ian; Coutroubis, Daphne M.; Miles, Kenneth A.

doi:10.1016/j.crad.2011.08.012

Cited by 288 publications

(232 citation statements)

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“…However, given the multitude of textural parameters that have been described and the complexities resulting from the measurement of local, regional, or global textural features, this assumption is probably an oversimplification of the relationships between tumor biology and heterogeneity within an image. For example, CT features related to increased heterogeneity, including increased entropy or decreased uniformity, predict poor response or survival (29,30,33). On the other hand, in 18 F-FDG PET of esophageal carcinoma, responders to treatment showed greater local heterogeneity at baseline, but measures of regional tumor heterogeneity showed better response stratification (19).…”

Section: Discussionmentioning

confidence: 99%

“…For example, changes in textural features related to the heterogeneity of CT images have been found to be independent predictors of time to progression in renal carcinomas treated with tyrosine kinase inhibitors (29), and textural features in unenhanced CT scans of esophageal carcinoma have been related to SUV parameters in corresponding 18 F-FDG PET scans and to tumor stage and survival (30). Specifically in lung cancer, CT features have been shown to help differentiate aggressive from nonaggressive NSCLC (31) and to show differences between histologic subtypes (32).…”

Section: Discussionmentioning

confidence: 99%

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Are Pretreatment ¹⁸F-FDG PET Tumor Textural Features in Non–Small Cell Lung Cancer Associated with Response and Survival After Chemoradiotherapy?

et al. 2012

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There is evidence in some solid tumors that textural features of tumoral uptake in 18 F-FDG PET images are associated with response to chemoradiotherapy and survival. We have investigated whether a similar relationship exists in non-small cell lung cancer (NSCLC). Methods: Fifty-three patients (mean age, 65.8 y; 31 men, 22 women) with NSCLC treated with chemoradiotherapy underwent pretreatment 18 F-FDG PET/CT scans. Response was assessed by CT Response Evaluation Criteria in Solid Tumors (RECIST) at 12 wk. Overall survival (OS), progression-free survival (PFS), and local PFS (LPFS) were recorded. Primary tumor texture was measured by the parameters coarseness, contrast, busyness, and complexity. The following parameters were also derived from the PET data: primary tumor standardized uptake values (SUVs) (mean SUV, maximum SUV, and peak SUV), metabolic tumor volume, and total lesion glycolysis. Results: Compared with nonresponders, RECIST responders showed lower coarseness (mean, 0.012 vs. 0.027; P 5 0.004) and higher contrast (mean, 0.11 vs. 0.044; P 5 0.002) and busyness (mean, 0.76 vs. 0.37; P 5 0.027). Neither complexity nor any of the SUV parameters predicted RECIST response. By Kaplan-Meier analysis, OS, PFS, and LPFS were lower in patients with high primary tumor coarseness (median, 21.1 mo vs. not reached, P 5 0.003; 12.6 vs. 25.8 mo, P 5 0.002; and 12.9 vs. 20.5 mo, P 5 0.016, respectively). Tumor coarseness was an independent predictor of OS on multivariable analysis. Contrast and busyness did not show significant associations with OS (P 5 0.075 and 0.059, respectively), but PFS and LPFS were longer in patients with high levels of each (for contrast: median of 20.5 vs. 12.6 mo, P 5 0.015, and median not reached vs. 24 mo, P 5 0.02; and for busyness: median of 20.5 vs. 12.6 mo, P 5 0.01, and median not reached vs. 24 mo, P 5 0.006). Neither complexity nor any of the SUV parameters showed significant associations with the survival parameters. Conclusion: In NSCLC, baseline 18 F-FDG PET scan uptake showing abnormal texture as measured by coarseness, contrast, and busyness is associated with nonresponse to chemoradiotherapy by RECIST and with poorer prognosis. Measurement of tumor metabolic heterogeneity with these parameters may provide indices that can be used to stratify patients in clinical trials for lung cancer chemoradiotherapy.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Are Pretreatment ¹⁸F-FDG PET Tumor Textural Features in Non–Small Cell Lung Cancer Associated with Response and Survival After Chemoradiotherapy?

et al. 2012

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“…A potentially easier approach is to evaluate tumor heterogeneity using imaging to assess how grainy or coarse a tumor seems to be. PET and CT have both been used to derive tumor textural information, and the appearance of the tumors has been shown to relate to patient outcome in esophageal and colorectal cancer (11)(12)(13).…”

Section: Introductionmentioning

confidence: 99%

Tumor Heterogeneity and Permeability as Measured on the CT Component of PET/CT Predict Survival in Patients with Non–Small Cell Lung Cancer

Win

Miles

Janes

et al. 2013

Clinical Cancer Research

190

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Purpose: We prospectively examined the role of tumor textural heterogeneity on positron emission tomography/computed tomography (PET/CT) in predicting survival compared with other clinical and imaging parameters in patients with non-small cell lung cancer (NSCLC).Experimental Design: The feasibility study consisted of 56 assessed consecutive patients with NSCLC (32 males, 24 females; mean age 67 AE 9.7 years) who underwent combined fluorodeoxyglucose (FDG) PET/ CT. The validation study population consisted of 66 prospectively recruited consecutive consenting patients with NSCLC (37 males, 29 females; mean age, 67.5 AE 7.8 years) who successfully underwent combined FDG PET/CT-dynamic contrast-enhanced (DCE) CT. Images were used to derive tumoral PET/CT textural heterogeneity, DCE CT permeability, and FDG uptake (SUV max ). The mean follow-up periods were 22.6 AE 13.3 months and 28.5AE 13.2 months for the feasibility and validation studies, respectively. Optimum threshold was determined for clinical stage and each of the above biomarkers (where available) from the feasibility study population. Kaplan-Meier analysis was used to assess the ability of the biomarkers to predict survival in the validation study. Cox regression determined survival factor independence.Results: Univariate analysis revealed that tumor CT-derived heterogeneity (P < 0.001), PET-derived heterogeneity (P ¼ 0.003), CT-derived permeability (P ¼ 0.002), and stage (P < 0Á001) were all significant survival predictors. The thresholds used in this study were derived from a previously conducted feasibility study. Tumor SUV max did not predict survival. Using multivariable analysis, tumor CT textural heterogeneity (P ¼ 0.021), stage (P ¼ 0.001), and permeability (P < 0.001) were independent survival predictors. These predictors were independent of patient treatment.Conclusions: Tumor stage and CT-derived textural heterogeneity were the best predictors of survival in NSCLC. The use of CT-derived textural heterogeneity should assist the management of many patients with NSCLC.

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“…These features could feasibly correlate with a metastatic phenotype, but more work is required in this area to understand the associations between tumour-stromal relationships and gene expression and/or metastatic potential (see section Molecular imaging of metastatic potential). Yet, the prognostic application of CT textural analysis has been validated in various tumours types, with coarser tumours pertaining to a poorer prognosis 24 ( Figure 3). In fact, overall survival (OS), progression-free survival (PFS) and local progressionfree survival were all lower in individuals with high primary tumour coarseness.…”

Section: Various Imaging Modalities and Methods That Can Help To Map mentioning

confidence: 99%

The use of molecular imaging combined with genomic techniques to understand the heterogeneity in cancer metastasis

Chowdhury¹,

Ganeshan²,

Irshad³

et al. 2014

BJR|case reports

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Tumour heterogeneity in oesophageal cancer assessed by CT texture analysis: Preliminary evidence of an association with tumour metabolism, stage, and survival

Cited by 288 publications

References 16 publications

Are Pretreatment ¹⁸F-FDG PET Tumor Textural Features in Non–Small Cell Lung Cancer Associated with Response and Survival After Chemoradiotherapy?

Are Pretreatment ¹⁸F-FDG PET Tumor Textural Features in Non–Small Cell Lung Cancer Associated with Response and Survival After Chemoradiotherapy?

Tumor Heterogeneity and Permeability as Measured on the CT Component of PET/CT Predict Survival in Patients with Non–Small Cell Lung Cancer

The use of molecular imaging combined with genomic techniques to understand the heterogeneity in cancer metastasis

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Tumour heterogeneity in oesophageal cancer assessed by CT texture analysis: Preliminary evidence of an association with tumour metabolism, stage, and survival

Cited by 288 publications

References 16 publications

Are Pretreatment 18F-FDG PET Tumor Textural Features in Non–Small Cell Lung Cancer Associated with Response and Survival After Chemoradiotherapy?

Are Pretreatment 18F-FDG PET Tumor Textural Features in Non–Small Cell Lung Cancer Associated with Response and Survival After Chemoradiotherapy?

Tumor Heterogeneity and Permeability as Measured on the CT Component of PET/CT Predict Survival in Patients with Non–Small Cell Lung Cancer

The use of molecular imaging combined with genomic techniques to understand the heterogeneity in cancer metastasis

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Are Pretreatment ¹⁸F-FDG PET Tumor Textural Features in Non–Small Cell Lung Cancer Associated with Response and Survival After Chemoradiotherapy?

Are Pretreatment ¹⁸F-FDG PET Tumor Textural Features in Non–Small Cell Lung Cancer Associated with Response and Survival After Chemoradiotherapy?