Early-stage non-small cell lung cancer

Quantitative imaging characteristics of 18F fluorodeoxyglucose PET/CT allow prediction of distant metastasis

Jia Wu, Todd Aguilera, David Shultz, Madhu Gudur, Daniel L. Rubin, Billy W. Loo, Maximilian Diehn, Ruijiang Li

Research output: Contribution to journalArticle

50 Citations (Scopus)

Abstract

Purpose: To identify quantitative imaging biomarkers at fluorine 18 (18F) positron emission tomography (PET) for predicting distant metastasis in patients with early-stage non-small cell lung cancer (NSCLC). Materials and Methods: In this institutional review board-approved HIPAA-compliant retrospective study, the pretreatment 18F fluorodeoxyglucose PET images in 101 patients treated with stereotactic ablative radiation therapy from 2005 to 2013 were analyzed. Data for 70 patients who were treated before 2011 were used for discovery purposes, while data from the remaining 31 patients were used for independent validation. Quantitative PET imaging characteristics including statistical, histogram-related, morphologic, and texture features were analyzed, from which 35 nonredundant and robust features were further evaluated. Cox proportional hazards regression model coupled with the least absolute shrinkage and selection operator was used to predict distant metastasis. Whether histologic type provided complementary value to imaging by combining both in a single prognostic model was also assessed. Results: The optimal prognostic model included two image features that allowed quantification of intratumor heterogeneity and peak standardized uptake value. In the independent validation cohort, this model showed a concordance index of 0.71, which was higher than those of the maximum standardized uptake value and tumor volume, with concordance indexes of 0.67 and 0.64, respectively. The prognostic model also allowed separation of groups with low and high risk for developing distant metastasis (hazard ratio, 4.8; P = .0498, log-rank test), which compared favorably with maximum standardized uptake value and tumor volume (hazard ratio, 1.5 and 2.0, respectively; P = .73 and 0.54, log-rank test, respectively). When combined with histologic types, the prognostic power was further improved (hazard ratio, 6.9; P = .0289, log-rank test; and concordance index, 0.80). Conclusion: PET imaging characteristics associated with distant metastasis that could potentially help practitioners to tailor appropriate therapy for individual patients with earlystage NSCLC were identified.

Original languageEnglish (US)
Pages (from-to)270-278
Number of pages9
JournalRadiology
Volume281
Issue number1
DOIs
StatePublished - Oct 1 2016

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Fluorodeoxyglucose F18
Non-Small Cell Lung Carcinoma
Positron-Emission Tomography
Neoplasm Metastasis
Tumor Burden
Health Insurance Portability and Accountability Act
Fluorine
Research Ethics Committees
Proportional Hazards Models
Radiotherapy
Retrospective Studies
Biomarkers

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

Early-stage non-small cell lung cancer : Quantitative imaging characteristics of 18F fluorodeoxyglucose PET/CT allow prediction of distant metastasis. / Wu, Jia; Aguilera, Todd; Shultz, David; Gudur, Madhu; Rubin, Daniel L.; Loo, Billy W.; Diehn, Maximilian; Li, Ruijiang.

In: Radiology, Vol. 281, No. 1, 01.10.2016, p. 270-278.

Research output: Contribution to journalArticle

Wu, Jia ; Aguilera, Todd ; Shultz, David ; Gudur, Madhu ; Rubin, Daniel L. ; Loo, Billy W. ; Diehn, Maximilian ; Li, Ruijiang. / Early-stage non-small cell lung cancer : Quantitative imaging characteristics of 18F fluorodeoxyglucose PET/CT allow prediction of distant metastasis. In: Radiology. 2016 ; Vol. 281, No. 1. pp. 270-278.
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abstract = "Purpose: To identify quantitative imaging biomarkers at fluorine 18 (18F) positron emission tomography (PET) for predicting distant metastasis in patients with early-stage non-small cell lung cancer (NSCLC). Materials and Methods: In this institutional review board-approved HIPAA-compliant retrospective study, the pretreatment 18F fluorodeoxyglucose PET images in 101 patients treated with stereotactic ablative radiation therapy from 2005 to 2013 were analyzed. Data for 70 patients who were treated before 2011 were used for discovery purposes, while data from the remaining 31 patients were used for independent validation. Quantitative PET imaging characteristics including statistical, histogram-related, morphologic, and texture features were analyzed, from which 35 nonredundant and robust features were further evaluated. Cox proportional hazards regression model coupled with the least absolute shrinkage and selection operator was used to predict distant metastasis. Whether histologic type provided complementary value to imaging by combining both in a single prognostic model was also assessed. Results: The optimal prognostic model included two image features that allowed quantification of intratumor heterogeneity and peak standardized uptake value. In the independent validation cohort, this model showed a concordance index of 0.71, which was higher than those of the maximum standardized uptake value and tumor volume, with concordance indexes of 0.67 and 0.64, respectively. The prognostic model also allowed separation of groups with low and high risk for developing distant metastasis (hazard ratio, 4.8; P = .0498, log-rank test), which compared favorably with maximum standardized uptake value and tumor volume (hazard ratio, 1.5 and 2.0, respectively; P = .73 and 0.54, log-rank test, respectively). When combined with histologic types, the prognostic power was further improved (hazard ratio, 6.9; P = .0289, log-rank test; and concordance index, 0.80). Conclusion: PET imaging characteristics associated with distant metastasis that could potentially help practitioners to tailor appropriate therapy for individual patients with earlystage NSCLC were identified.",
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AU - Aguilera, Todd

AU - Shultz, David

AU - Gudur, Madhu

AU - Rubin, Daniel L.

AU - Loo, Billy W.

AU - Diehn, Maximilian

AU - Li, Ruijiang

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AB - Purpose: To identify quantitative imaging biomarkers at fluorine 18 (18F) positron emission tomography (PET) for predicting distant metastasis in patients with early-stage non-small cell lung cancer (NSCLC). Materials and Methods: In this institutional review board-approved HIPAA-compliant retrospective study, the pretreatment 18F fluorodeoxyglucose PET images in 101 patients treated with stereotactic ablative radiation therapy from 2005 to 2013 were analyzed. Data for 70 patients who were treated before 2011 were used for discovery purposes, while data from the remaining 31 patients were used for independent validation. Quantitative PET imaging characteristics including statistical, histogram-related, morphologic, and texture features were analyzed, from which 35 nonredundant and robust features were further evaluated. Cox proportional hazards regression model coupled with the least absolute shrinkage and selection operator was used to predict distant metastasis. Whether histologic type provided complementary value to imaging by combining both in a single prognostic model was also assessed. Results: The optimal prognostic model included two image features that allowed quantification of intratumor heterogeneity and peak standardized uptake value. In the independent validation cohort, this model showed a concordance index of 0.71, which was higher than those of the maximum standardized uptake value and tumor volume, with concordance indexes of 0.67 and 0.64, respectively. The prognostic model also allowed separation of groups with low and high risk for developing distant metastasis (hazard ratio, 4.8; P = .0498, log-rank test), which compared favorably with maximum standardized uptake value and tumor volume (hazard ratio, 1.5 and 2.0, respectively; P = .73 and 0.54, log-rank test, respectively). When combined with histologic types, the prognostic power was further improved (hazard ratio, 6.9; P = .0289, log-rank test; and concordance index, 0.80). Conclusion: PET imaging characteristics associated with distant metastasis that could potentially help practitioners to tailor appropriate therapy for individual patients with earlystage NSCLC were identified.

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