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Open AccessArticle

18F-FDG Pet Parameters and Radiomics Features Analysis in Advanced Nsclc Treated with Immunotherapy as Predictors of Therapy Response and Survival

1
Division of Nuclear Medicine, Department of Medical Sciences, University of Turin, AOU Città della Salute e della Scienza, 10126 Turin, Italy
2
PET/CT Center, Affidea IRMET, 10135 Turin, Italy
3
Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, 10043 Torino, Italy
4
Medical Physics Unit, S.C. Fisica Sanitaria, A.O.U. Città della Salute e della Scienza, 10135 Turin, Italy
5
Nuclear Medicine, Istituto per la Ricerca e la Cura del Cancro (IRCC), 10060 Candiolo, Italy
6
Radiology Unit, Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, 10043 Torino, Italy
*
Author to whom correspondence should be addressed.
These authors contributed equally to this work.
Cancers 2020, 12(5), 1163; https://doi.org/10.3390/cancers12051163
Received: 11 March 2020 / Revised: 21 April 2020 / Accepted: 30 April 2020 / Published: 5 May 2020
(This article belongs to the Special Issue Role of Medical Imaging in Cancers)
Objectives: (1.1) to evaluate the association between baseline 18F-FDG PET/CT semi-quantitative parameters of the primary lesion with progression free survival (PFS), overall survival (OS) and response to immunotherapy, in advanced non-small cell lung carcinoma (NSCLC) patients eligible for immunotherapy; (1.2) to evaluate the application of radiomics analysis of the primary lesion to identify features predictive of response to immunotherapy; (1.3) to evaluate if tumor burden assessed by 18F-FDG PET/CT (N and M factors) is associated with PFS and OS. Materials and Methods: we retrospectively analyzed clinical records of advanced NCSLC patients (stage IIIb/c or stage IV) candidate to immunotherapy who performed 18F-FDG PET/CT before treatment to stage the disease. Fifty-seven (57) patients were included in the analysis (F:M 17:40; median age = 69 years old). Notably, 38/57 of patients had adenocarcinoma (AC), 10/57 squamous cell carcinoma (SCC) and 9/57 were not otherwise specified (NOS). Overall, 47.4% patients were stage IVA, 42.1% IVB and 8.8% IIIB. Immunotherapy was performed as front-line therapy in 42/57 patients and as second line therapy after chemotherapy platinum-based in 15/57. The median follow up after starting immunotherapy was 10 months (range: 1.5–68.6). Therapy response was assessed by RECIST 1.1 criteria (CT evaluation every 4 cycles of therapy) in 48/57 patients or when not feasible by clinical and laboratory data (fast disease progression or worsening of patient clinical condition in nine patients). Radiomics analysis was performed by applying regions of interest (ROIs) of the primary tumor delineated manually by two operators and semi-automatically applying a threshold at 40% of SUVmax. Results: (1.1) metabolic tumor volume (MTV) (p = 0.028) and total lesion glycolysis (TLG) (p = 0.035) were significantly associated with progressive vs. non-progressive disease status. Patients with higher values of MTV and TLG had higher probability of disease progression, compared to those patients presenting with lower values. SUVmax did not show correlation with PD status, PFS and OS. MTV (p = 0.027) and TLG (p = 0.022) also resulted in being significantly different among PR, SD and PD groups, while SUVmax was confirmed to not be associated with response to therapy (p = 0.427). (1.2) We observed the association of several radiomics features with PD status. Namely, patients with high tumor volume, TLG and heterogeneity expressed by “skewness” and “kurtosis” had a higher probability of failing immunotherapy. (1.3) M status at 18F-FDG PET/CT was significantly associated with PFS (p = 0.002) and OS (p = 0.049). No significant associations were observed for N status. Conclusions: 18F-FDG PET/CT performed before the start of immunotherapy might be an important prognostic tool able to predict the disease progression and response to immunotherapy in patients with advanced NSCLC, since MTV, TLG and radiomics features (volume and heterogeneity) are associated with disease progression. View Full-Text
Keywords: PET/CT; immunotherapy; PD-1; PD-L1; response to therapy; NSCLC PET/CT; immunotherapy; PD-1; PD-L1; response to therapy; NSCLC
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MDPI and ACS Style

Polverari, G.; Ceci, F.; Bertaglia, V.; Reale, M.L.; Rampado, O.; Gallio, E.; Passera, R.; Liberini, V.; Scapoli, P.; Arena, V.; Racca, M.; Veltri, A.; Novello, S.; Deandreis, D. 18F-FDG Pet Parameters and Radiomics Features Analysis in Advanced Nsclc Treated with Immunotherapy as Predictors of Therapy Response and Survival. Cancers 2020, 12, 1163. https://doi.org/10.3390/cancers12051163

AMA Style

Polverari G, Ceci F, Bertaglia V, Reale ML, Rampado O, Gallio E, Passera R, Liberini V, Scapoli P, Arena V, Racca M, Veltri A, Novello S, Deandreis D. 18F-FDG Pet Parameters and Radiomics Features Analysis in Advanced Nsclc Treated with Immunotherapy as Predictors of Therapy Response and Survival. Cancers. 2020; 12(5):1163. https://doi.org/10.3390/cancers12051163

Chicago/Turabian Style

Polverari, Giulia; Ceci, Francesco; Bertaglia, Valentina; Reale, Maria L.; Rampado, Osvaldo; Gallio, Elena; Passera, Roberto; Liberini, Virginia; Scapoli, Paola; Arena, Vincenzo; Racca, Manuela; Veltri, Andrea; Novello, Silvia; Deandreis, Désirée. 2020. "18F-FDG Pet Parameters and Radiomics Features Analysis in Advanced Nsclc Treated with Immunotherapy as Predictors of Therapy Response and Survival" Cancers 12, no. 5: 1163. https://doi.org/10.3390/cancers12051163

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