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Nuklearmedizin 2022; 61(05): 385-393
DOI: 10.1055/a-1816-6950
Original Article

Standardized 18F-FDG PET/CT radiomic features provide information on PD-L1 expression status in treatment-naïve patients with non-small cell lung cancer

Standardisierte 18F-FDG PET/CT Radiomics beinhalten Informationen zum PD-L1 Expressionsstatus in therapie-naïven Patienten mit Nicht-Kleinzelligen-Lungenkarzinom
Ruiyun Zhang   *
1   Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany (Ringgold ID: RIN488222)
2   Pathology, Klinikum Bayreuth GmbH, Bayreuth, Germany (Ringgold ID: RIN15019)
3   Nuclear Medicine, Klinikum Bayreuth GmbH, Bayreuth, Germany (Ringgold ID: RIN15019)
,
Wolfgang Hohenforst-Schmidt
4   Pneumology, Sana Klinikum Hof GmbH, Hof, Germany (Ringgold ID: RIN40643)
,
Claus Steppert
5   Pneumology, Klinikum Coburg GmbH, Coburg, Germany (Ringgold ID: RIN15020)
,
Zsolt Sziklavari
6   Thoracic Surgery, Klinikum Coburg GmbH, Coburg, Germany (Ringgold ID: RIN15020)
,
Christian Schmidkonz
7   Nuclear Medicine, Universitätsklinikum Erlangen, Erlangen, Germany (Ringgold ID: RIN27168)
,
Armin Atzinger
7   Nuclear Medicine, Universitätsklinikum Erlangen, Erlangen, Germany (Ringgold ID: RIN27168)
,
Torsten Kuwert
7   Nuclear Medicine, Universitätsklinikum Erlangen, Erlangen, Germany (Ringgold ID: RIN27168)
,
Thorsten Klink
8   Radiology, Universitätsklinikum Würzburg, Wurzburg, Germany (Ringgold ID: RIN27207)
9   Medizincampus Oberfranken, Universitätsklinikum Erlangen, Bayreuth, Germany (Ringgold ID: RIN27168)
10   Radiology, Klinikum Bayreuth GmbH, Bayreuth, Germany (Ringgold ID: RIN15019)
,
William Sterlacci
1   Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany (Ringgold ID: RIN488222)
2   Pathology, Klinikum Bayreuth GmbH, Bayreuth, Germany (Ringgold ID: RIN15019)
,
Arndt Hartmann
1   Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany (Ringgold ID: RIN488222)
,
Michael Vieth
9   Medizincampus Oberfranken, Universitätsklinikum Erlangen, Bayreuth, Germany (Ringgold ID: RIN27168)
1   Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany (Ringgold ID: RIN488222)
2   Pathology, Klinikum Bayreuth GmbH, Bayreuth, Germany (Ringgold ID: RIN15019)
,
Stefan Förster
11   Nuclear Medicine, Klinikum rechts der Isar der Technischen Universität München, Munchen, Germany (Ringgold ID: RIN27190)
9   Medizincampus Oberfranken, Universitätsklinikum Erlangen, Bayreuth, Germany (Ringgold ID: RIN27168)
3   Nuclear Medicine, Klinikum Bayreuth GmbH, Bayreuth, Germany (Ringgold ID: RIN15019)
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Abstract

Purpose To study the relationship between standardized 18F-FDG PET/CT radiomic features and clinicopathological variables and programmed death ligand-1 (PD-L1) expression status in non-small cell lung cancer (NSCLC) patients.

Methods 58 NSCLC patients with preoperative 18F-FDG PET/CT scans and postoperative results of PD-L1 expression were retrospectively analysed. A standardized, open-source software was used to extract 86 radiomic features from PET and low-dose CT images. Univariate analysis and multivariate logistic regression were used to find independent predictors of PD-L1 expression. The Area Under the Curve (AUC) of receiver operating characteristic (ROC) curve was used to compare the ability of variables and their combination in predicting PD-L1 expression.

Results Multivariate logistic regression resulted in the PET radiomic feature GLRLM_LGRE (Odds Rate (OR): 0.300 vs 0.114, 95% confidence interval (CI): 0.096–0.931 vs 0.021–0.616, in NSCLC and adenocarcinoma respectively) and the CT radiomic feature GLZLM_SZE (OR: 3.338 vs 7.504, 95%CI: 1.074–10.375 vs 1.382–40.755, in NSCLC and adenocarcinoma respectively), being independent predictors of PD-L1 status. In NSCLC group, after adjusting for gender and histology, the PET radiomic feature GLRLM_LGRE (OR: 0.282, 95%CI: 0.085–0.936) remained an independent predictor for PD-L1 status. In the adenocarcinoma group, when adjusting for gender the PET radiomic feature GLRLM_LGRE (OR: 0.115, 95%CI: 0.021–0.631) and the CT radiomic feature GLZLM_SZE (OR: 7.343, 95%CI: 1.285–41.965) remained associated with PD-L1 expression.

Conclusion NSCLC and adenocarcinoma with PD-L1 expression show higher tumour heterogeneity. Heterogeneity-related 18F-FDG PET and CT radiomic features showed good ability to non-invasively predict PD-L1 expression.

Zusammenfassung

Ziel Untersuchung der Beziehung zwischen standardisierten 18F-FDG-PET/CT-Radiomics-Merkmalen, klinisch-pathologischen Variablen und der Expression des Programmed Death Ligand 1 (PD-L1) bei Patienten mit nichtkleinzelligem Bronchialkarzinom (non-small cell lung cancer, NSCLC).

Material und Methoden 58 NSCLC-Patienten mit präoperativen 18F-FDG-PET/CT-Scans und postoperativen Befunden zur PD-L1-Expression wurden retrospektiv analysiert. Eine standardisierte Open-Source-Software wurde verwendet, um 86 Radiomics-Merkmale aus PET- und Niedrigdosis-CT-Bildern zu extrahieren. Univariate Analyse und multivariate logistische Regression wurden verwendet, um unabhängige Prädiktoren für die PD-L1-Expression zu ermitteln. Die Fläche unter der Kurve (AUC) der Receiver-Operating-Characteristic (ROC) -Kurve wurde verwendet, um die Fähigkeit der Variablen und ihrer Kombination bei der Vorhersage der PD-L1-Expression zu vergleichen.

Ergebnisse Die multivariate logistische Regression ergab das PET-Radiomics-Merkmal GLRLM_LGRE (Odds Ratio (OR): 0,300 vs. 0,114, 95%-Konfidenzintervall (KI): 0,096–0,931 vs. 0,021–0,616, bei NSCLC bzw. Adenokarzinom) und das CT-Radiomics-Merkmal GLZLM_SZE (OR: 3,338 vs. 7,504, 95%-KI: 1,074–10,375 vs. 1,382–40,755, bei NSCLC bzw. Adenokarzinom), wobei es sich um unabhängige Prädiktoren für den PD-L1-Status handelt.

In der NSCLC-Gruppe blieb das PET-Radiomics-Merkmal GLRLM_LGRE (OR: 0,282, 95%-KI: 0,085–0,936) nach Berücksichtigung von Geschlecht und Histologie ein unabhängiger Prädiktor für den PD-L1-Status. In der Adenokarzinom-Gruppe waren nach Berücksichtigung des Geschlechts das PET-Radiomics-Merkmal GLRLM_LGRE (OR: 0,115, 95%-KI: 0,021–0,631) und das CT-Radiomics-Merkmal GLZLM_SZE (OR: 7,343, 95%-KI: 1,285–41,965) mit der PD-L1-Expression assoziiert.

Schlussfolgerung NSCLC und Adenokarzinome mit PD-L1-Expression zeigen eine höhere Tumorheterogenität. Heterogenitätsbezogene 18F-FDG-PET- und CT-Radiomics-Merkmale zeigten eine gute Fähigkeit zur nichtinvasiven Vorhersage der PD-L1-Expression.

Schlüsselwörter

PD-L1 - 18F-FDG - PET - PET/CT - NSCLC - Radiomics

Keywords

PD-L1 - 18F-FDG - PET - PET/CT - NSCLC - radiomics

* The present work was performed in (partial) fulfillment of the requirements for obtaining the degree „Dr. med.“/„Dr. med. dent“.


Supporting information



Publication History

Received: 24 February 2022

Accepted after revision: 04 April 2022

Article published online:
29 June 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
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