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Additional value of metabolic parameters to PET/CT-based radiomics nomogram in predicting lymphovascular invasion and outcome in lung adenocarcinoma

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

A Correction to this article was published on 28 July 2020

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Abstract

Purpose

Lymphovascular invasion (LVI) impairs surgical outcomes in lung adenocarcinoma (LAC) patients. Preoperative prediction of LVI is challenging by using traditional clinical and imaging parameters. The purpose of this study was to investigate the value of the radiomics nomogram integrating clinical factors, CT features, and maximum standardized uptake value (SUVmax) to predict LVI and outcome in LAC and to evaluate the additional value of the SUVmax to the PET/CT-based radiomics nomogram.

Methods

A total of 272 LAC patients (87 LVI-present LACs and 185 LVI-absent LACs) with PET/CT scans were retrospectively enrolled, and 160 patients with SUVmax ≥ 2.5 of them were used for PET radiomics analysis. Clinical data and CT features were analyzed to select independent LVI predictors. The performance of the independent LVI predictors and SUVmax was evaluated. Two-dimensional (2D) and three-dimensional (3D) CT radiomics signatures (RSs) and PET-RS were constructed with the least absolute shrinkage and selection operator algorithm and radiomics scores (Rad-scores) were calculated. The radiomics nomograms, incorporating Rad-score and independent clinical and CT factors, with SUVmax (RNWS) or without SUVmax (RNWOS) were built. The performance of the models was assessed with respect to calibration, discrimination, and clinical usefulness. All the clinical, PET/CT, pathologic, therapeutic, and radiomics parameters were assessed to identify independent predictors of progression-free survival (PFS).

Results

CT morphology was the independent LVI predictor. SUVmax provided better discrimination capability compared with CT morphology in the training set (P < 0.001) and test set (P = 0.042). A total of 1409 CT and PET radiomics features were extracted and reduced to 8, 8, and 10 features to build the 2D CT-RS, 3D CT-RS, and the PET-RS, respectively. There was no significant difference in AUC between the 2D-RS and 3D-RS (P > 0.05), and 2D CT-RS showed a relatively higher AUC than 3D CT-RS. The CT-RS, the CT-RNWOS, and the CT-RNWS showed good discrimination in the training set (AUC [area under the curve], 0.799, 0.796, and 0.851, respectively) and the test set (AUC, 0.818, 0.822, and 0.838, respectively). There was significant difference in AUC between the CT-RNWS and CT-RNWOS (P = 0.044) in the training set. Decision curve analysis (DCA) demonstrated the CT-RNWS outperformed the CT-RS and the CT-RNWOS in terms of clinical usefulness. Furthermore, DCA showed the PETCT-RNWS provided the highest net benefit compared with the PET-RNWS and CT-RNWS. PFS was significantly different between the pathologic and RNWS-predicted LVI-present and LVI-absent patients (P < 0.001). Carbohydrate antigen 125 (CA125), carcinoembryonic antigen (CEA), neuron-specific enolase (NSE), pathologic LVI, histologic subtype, and SUVmax were independent predictors of PFS in the 244 CT-RNWS-predicted cohort; and CA125, NSE, pathologic LVI, and SUVmax were the independent predictors of PFS in the 141 PETCT-RNWS-predicted cohort.

Conclusions

The radiomics nomogram, incorporating Rad-score, clinical and PET/CT parameters, shows favorable predictive efficacy for LVI status in LAC. Pathologic LVI and SUVmax are associated with LAC prognosis.

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Data availability

The datasets generated and analyzed during the current study are not publicly available due to patient privacy concerns but are available from the corresponding author on reasonable request.

Change history

  • 28 July 2020

    Figures 1 and 4 are incorrect in the original manuscript.

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Funding

This study was funded by the National Natural Science Foundation of China (81701688 and 81601527); the Science and Technology Project of Southern District of Qingdao City (2020-2-004-YY); the Natural Science Foundation of Shandong Province (ZR2017BH096 and ZR2017MH036); the Key Research and Development Project of Shandong Province (2018GSF118078); and the Postdoctoral Science Foundation of China (2018 M642617).

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Author notes

  1. Pei Nie and Guangjie Yang contributed equally to this work.

Authors and Affiliations

  1. Department of Radiology, The Affiliated Hospital of Qingdao University, No. 16 Jiangsu Road, Qingdao, Shandong, China

    Pei Nie

  2. Department of Nuclear Medicine, The Affiliated Hospital of Qingdao University, No. 59 Haier Road, Qingdao, Shandong, China

    Guangjie Yang, Lei Yan, Wenjie Miao, Yanli Duan, Aidi Gong, Yujun Zhao, Mingming Yu, Dacheng Li, Yanqin Sun, Yangyang Wang & Zhenguang Wang

  3. Department of Radiology, Shandong Provincial Hospital, No. 324 Jingwu Road, Jinan, Shandong, China

    Ning Wang

  4. PET-CT Center, Qingdao Central Hospital, No. 127 Siliu South Road, Qingdao, Shandong, China

    Yanli Wang

  5. Department of Pathology, The Affiliated Hospital of Qingdao University, No. 16 Jiangsu Road, Qingdao, Shandong, China

    Jie Wu

  6. Department of Oncology, The Affiliated Hospital of Qingdao University, No. 16 Jiangsu Road, Qingdao, Shandong, China

    Chuantao Zhang

  7. Department of Thoracic Surgery, The Affiliated Hospital of Qingdao University, No. 16 Jiangsu Road, Qingdao, Shandong, China

    Maolong Wang

  8. Huiying Medical Technology Co., Ltd, No. 66 Xixiaokou Road, Beijing, China

    Jingjing Cui

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  1. Pei Nie
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Contributions

Literature search: Pei Nie, Guangjie Yang; Study design: Zhenguang Wang; Data collection: Pei Nie, Guangjie Yang, Yan Lei, Wenjie Miao, Yanli Duan, Yanli Wang, Aidi Gong, Yujun Zhao, Jie Wu, Chuantao Zhang, Maolong Wang, Mingming Yu, Dacheng Li; Data analysis: Guangjie Yang, Pei Nie, Ning Wang, Jingjing Cui, Yanqin Sun, Yangyang Wang; Manuscript writing: Pei Nie, Guangjie Yang; Manuscript review: Zhenguang Wang. All the authors read and approved the final manuscript.

Corresponding author

Correspondence to Zhenguang Wang.

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The authors declare that they have no conflicts of interest.

Research involving human participants

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee of The Affiliated Hospital of Qingdao University (Approval No. QYFY WZLL 25580) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was waived for this retrospective study.

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The original version of this article was revised. Figures 1 and 4 are updated.

This article is part of the Topical Collection on Oncology - Chest

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Nie, P., Yang, G., Wang, N. et al. Additional value of metabolic parameters to PET/CT-based radiomics nomogram in predicting lymphovascular invasion and outcome in lung adenocarcinoma. Eur J Nucl Med Mol Imaging 48, 217–230 (2021). https://doi.org/10.1007/s00259-020-04747-5

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