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FDG PET/CT radiomics for predicting the outcome of locally advanced rectal cancer

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Abstract

Purpose

The aim of this study was to investigate the prognostic value of baseline 18F-FDG PET/CT textural analysis in locally-advanced rectal cancer (LARC).

Methods

Eighty-six patients with LARC underwent 18F-FDG PET/CT before treatment. Maximum and mean standard uptake values (SUVmax and SUVmean), metabolic tumoral volume (MTV), total lesion glycolysis (TLG), histogram-intensity features, as well as 11 local and regional textural features, were evaluated. The relationships of clinical, pathological and PET-derived metabolic parameters with disease-specific survival (DSS), disease-free survival (DFS) and overall survival (OS) were assessed by Cox regression analysis. Logistic regression was used to predict the pathological response by the Dworak tumor regression grade (TRG) in the 66 patients treated with neoadjuvant chemoradiotherapy (nCRT).

Results

The median follow-up of patients was 41 months. Seventeen patients (19.7%) had recurrent disease and 18 (20.9 %) died, either due to cancer progression (n = 10) or from another cause while in complete remission (n = 8). DSS was 95% at 1 year, 93% at 2 years and 87% at 4 years. Weight loss, surgery and the texture parameter coarseness were significantly associated with DSS in multivariate analyses. DFS was 94 % at 1 year, 86 % at 2 years and 79 % at 4 years. From a multivariate standpoint, tumoral differentiation and the texture parameters homogeneity and coarseness were significantly associated with DFS. OS was 93% at 1 year, 87% at 2 years and 79% after 4 years. cT, surgery, SUVmean, dissimilarity and contrast from the neighborhood intensity-difference matrix (contrastNGTDM) were significantly and independently associated with OS. Finally, RAS-mutational status (KRAS and NRAS mutations) and TLG were significant predictors of pathological response to nCRT (TRG 3-4).

Conclusion

Textural analysis of baseline 18F-FDG PET/CT provides strong independent predictors of survival in patients with LARC, with better predictive power than intensity- and volume-based parameters. The utility of such features, especially coarseness, should be confirmed by larger clinical studies before considering their potential integration into decisional algorithms aimed at personalized medicine.

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Acknowledgments

We thank our colleague André Frère, from the department of Gastro-enterology of the CHR of Liege, who granted us access to data from patients followed in his hospital, Sébastien Jodogne, from the department of Medical Physics of the CHU of Liege, for the design of the textural analysis software, and Stéphanie Gofflot, from the Biobank of the University of Liege, for providing tumoral samples for genetic analyzes.

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Authors and Affiliations

  1. Division of Nuclear Medicine and Oncological Imaging, Department of Medical Physics CHU, University of Liège, B35 Domaine Universitaire du Sart-Tilman, 4000, Liege, Belgium

    Pierre Lovinfosse & Roland Hustinx

  2. Department of Gastro-enterology, Centre Hospitalier Universitaire de Liège, Liège, Belgium

    Marc Polus & Daniel Van Daele

  3. Division of Radiation Oncology, Department of Medical Physics, CHU and University of Liège, Liège, Belgium

    Philippe Martinive

  4. Department of Nuclear Medicine, Centre Hospitalier Régional de la Citadelle, Liège, Belgium

    Frédéric Daenen

  5. LaTIM, INSERM UMR 1101, Brest, France

    Mathieu Hatt & Dimitris Visvikis

  6. Center for Human Genetic, Molecular Haemato-Oncology Unit, UniLab Liège, Centre Hospitalier Universitaire de Liège, Liège, Belgium

    Benjamin Koopmansch & Frédéric Lambert

  7. Department of Abdominal Surgery and Transplantation, Centre Hospitalier Universitaire de Liège, Liège, Belgium

    Carla Coimbra

  8. Department of Biostatistics and Medico-economic Information, Centre Hospitalier Universitaire de Liège, Liège, Belgium

    Laurence Seidel & Adelin Albert

  9. Department of Pathology, Centre Hospitalier Universitaire de Liège, Liège, Belgium

    Philippe Delvenne

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  1. Pierre Lovinfosse
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Correspondence to Pierre Lovinfosse.

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All procedures were performed in accordance with the principles of the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. The study design and exemption from informed consent were approved by the Institutional Review Board of Liege University Hospital.

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Lovinfosse, P., Polus, M., Van Daele, D. et al. FDG PET/CT radiomics for predicting the outcome of locally advanced rectal cancer. Eur J Nucl Med Mol Imaging 45, 365–375 (2018). https://doi.org/10.1007/s00259-017-3855-5

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  • DOI: https://doi.org/10.1007/s00259-017-3855-5

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