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Theranostics 2018; 8(21):5915-5928. doi:10.7150/thno.28018 This issue Cite

Research Paper

Radiomic signature of ¹⁸F fluorodeoxyglucose PET/CT for prediction of gastric cancer survival and chemotherapeutic benefits

Yuming Jiang^1*, Qingyu Yuan^2*, Wenbing Lv^3*, Sujuan Xi^4,5*, Weicai Huang¹, Zepang Sun¹, Hao Chen¹, Liying Zhao¹, Wei Liu⁴, Yanfeng Hu¹, Lijun Lu³, Jianhua Ma³, Tuanjie Li^1✉, Jiang Yu^1✉, Quanshi Wang^2✉, Guoxin Li^1✉

1. Department of General Surgery, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou, China;
2. Nanfang PET Center, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, 510515, China;
3. School of Biomedical Engineering and Guangdong Provincal Key Laboratory of Medical Image Processing, Southern Medical University, Guangzhou, Guangdong, 510515, China;
4. Guangdong Key Laboratory of Liver Disease Research, the 3rd Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510630, China;
5. Department of Infectious Disease, the 3rd Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
*These authors contributed equally to this work.

✉ Corresponding authors: Guoxin Li, Department of General Surgery, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou, 510515, China; Tel and Fax: +86-20-6278 7170; E-mail: gzliguoxincom or jiangymbestcom; Quanshi Wang, Nanfang PET Center, Nanfang Hospital, Southern Medical University, 1838 Guangzhou Avenue North, Guangzhou, Guangdong Province 510515, China Tel/fax: +86-20-6164 2127; e-mail: wqslphnet; Jiang Yu, Department of General Surgery, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou, 510515, China; Tel and Fax: +86-20-6278 7170; E-mail: balbccom; Tuanjie Li, Department of General Surgery, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou, 510515, China; Tel and Fax: +86-20-6278 7170; E-mail: ehbhltjcom. More

Abstract

We aimed to evaluate whether radiomic feature-based fluorine 18 (¹⁸F) fluorodeoxyglucose (FDG) positron emission tomography (PET) imaging signatures allow prediction of gastric cancer (GC) survival and chemotherapy benefits.

Methods: A total of 214 GC patients (training (n = 132) or validation (n = 82) cohort) were subjected to radiomic feature extraction (80 features). Radiomic features of patients in the training cohort were subjected to a LASSO cox analysis to predict disease-free survival (DFS) and overall survival (OS) and were validated in the validation cohort. A radiomics nomogram with the radiomic signature incorporated was constructed to demonstrate the incremental value of the radiomic signature to the TNM staging system for individualized survival estimation, which was then assessed with respect to calibration, discrimination, and clinical usefulness. The performance was assessed with concordance index (C-index) and integrated Brier scores.

Results: Significant differences were found between the high- and low-radiomic score (Rad-score) patients in 5-year DFS and OS in training and validation cohorts. Multivariate analysis revealed that the Rad-score was an independent prognostic factor. Incorporating the Rad-score into the radiomics-based nomogram resulted in better performance (C-index: DFS, 0.800; OS, 0.786; in the training cohort) than TNM staging system and clinicopathologic nomogram. Further analysis revealed that patients with higher Rad-scores were prone to benefit from chemotherapy.

Conclusion: The newly developed radiomic signature was a powerful predictor of OS and DFS. Moreover, the radiomic signature could predict which patients could benefit from chemotherapy.

Keywords: gastric cancer, prognosis, chemotherapy, predictive signature, PET/CT

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