title: Stage III Non-Small Cell Lung Cancer: Prognostic Value of FDG PET Quantitative Imaging Features Combined with Clinical Prognostic Factors.
abstract: OBJECTIVE
  To determine whether quantitative imaging features from pretreatment positron emission tomography (PET) can enhance patient overall survival risk stratification beyond what can be achieved with conventional prognostic factors in patients with stage III non-small cell lung cancer (NSCLC).
  
  
  METHODS
  The institutional review board approved this retrospective chart review study and waived the requirement to obtain informed consent. The authors retrospectively identified 195 patients with stage III NSCLC treated definitively with radiation therapy between January 2008 and January 2013. All patients underwent pretreatment PET/computed tomography before treatment. Conventional PET metrics, along with histogram, shape and volume, and co-occurrence matrix features, were extracted. Linear predictors of overall survival were developed from leave-one-out cross-validation. Predictive Kaplan-Meier curves were used to compare the linear predictors with both quantitative imaging features and conventional prognostic factors to those generated with conventional prognostic factors alone. The Harrell concordance index was used to quantify the discriminatory power of the linear predictors for survival differences of at least 0, 6, 12, 18, and 24 months. Models were generated with features present in more than 50% of the cross-validation folds.
  
  
  RESULTS
  Linear predictors of overall survival generated with both quantitative imaging features and conventional prognostic factors demonstrated improved risk stratification compared with those generated with conventional prognostic factors alone in terms of log-rank statistic (P = .18 vs P = .0001, respectively) and concordance index (0.62 vs 0.58, respectively). The use of quantitative imaging features selected during cross-validation improved the model using conventional prognostic factors alone (P = .007). Disease solidity and primary tumor energy from the co-occurrence matrix were found to be selected in all folds of cross-validation.
  
  
  CONCLUSIONS
  Pretreatment PET features were associated with overall survival when adjusting for conventional prognostic factors in patients with stage III NSCLC.
authors.affiliation: From the Departments of Radiation Physics (D.V.F., O.M., L.Z., X.F., G.I., L.E.C.), Imaging Physics (O.M.), Biostatistics (S.Z.), and Radiation Oncology (Z.L.), the University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030; and Graduate School of Biomedical Sciences, the University of Texas Health Science Center at Houston, Houston, Tex (D.V.F., X.F., G.I., L.E.C.).
authors.forename: David V
authors.initials: DV
authors.lastname: Fried
authors.affiliation: From the Departments of Radiation Physics (D.V.F., O.M., L.Z., X.F., G.I., L.E.C.), Imaging Physics (O.M.), Biostatistics (S.Z.), and Radiation Oncology (Z.L.), the University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030; and Graduate School of Biomedical Sciences, the University of Texas Health Science Center at Houston, Houston, Tex (D.V.F., X.F., G.I., L.E.C.).
authors.forename: Osama
authors.initials: O
authors.lastname: Mawlawi
authors.affiliation: From the Departments of Radiation Physics (D.V.F., O.M., L.Z., X.F., G.I., L.E.C.), Imaging Physics (O.M.), Biostatistics (S.Z.), and Radiation Oncology (Z.L.), the University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030; and Graduate School of Biomedical Sciences, the University of Texas Health Science Center at Houston, Houston, Tex (D.V.F., X.F., G.I., L.E.C.).
authors.forename: Lifei
authors.initials: L
authors.lastname: Zhang
authors.affiliation: From the Departments of Radiation Physics (D.V.F., O.M., L.Z., X.F., G.I., L.E.C.), Imaging Physics (O.M.), Biostatistics (S.Z.), and Radiation Oncology (Z.L.), the University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030; and Graduate School of Biomedical Sciences, the University of Texas Health Science Center at Houston, Houston, Tex (D.V.F., X.F., G.I., L.E.C.).
authors.forename: Xenia
authors.initials: X
authors.lastname: Fave
authors.affiliation: From the Departments of Radiation Physics (D.V.F., O.M., L.Z., X.F., G.I., L.E.C.), Imaging Physics (O.M.), Biostatistics (S.Z.), and Radiation Oncology (Z.L.), the University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030; and Graduate School of Biomedical Sciences, the University of Texas Health Science Center at Houston, Houston, Tex (D.V.F., X.F., G.I., L.E.C.).
authors.forename: Shouhao
authors.initials: S
authors.lastname: Zhou
authors.affiliation: From the Departments of Radiation Physics (D.V.F., O.M., L.Z., X.F., G.I., L.E.C.), Imaging Physics (O.M.), Biostatistics (S.Z.), and Radiation Oncology (Z.L.), the University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030; and Graduate School of Biomedical Sciences, the University of Texas Health Science Center at Houston, Houston, Tex (D.V.F., X.F., G.I., L.E.C.).
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Ibbott
authors.affiliation: From the Departments of Radiation Physics (D.V.F., O.M., L.Z., X.F., G.I., L.E.C.), Imaging Physics (O.M.), Biostatistics (S.Z.), and Radiation Oncology (Z.L.), the University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030; and Graduate School of Biomedical Sciences, the University of Texas Health Science Center at Houston, Houston, Tex (D.V.F., X.F., G.I., L.E.C.).
authors.forename: Zhongxing
authors.initials: Z
authors.lastname: Liao
authors.affiliation: From the Departments of Radiation Physics (D.V.F., O.M., L.Z., X.F., G.I., L.E.C.), Imaging Physics (O.M.), Biostatistics (S.Z.), and Radiation Oncology (Z.L.), the University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030; and Graduate School of Biomedical Sciences, the University of Texas Health Science Center at Houston, Houston, Tex (D.V.F., X.F., G.I., L.E.C.).
authors.forename: Laurence E
authors.initials: LE
authors.lastname: Court
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging* / Q000473:pathology; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography; D011379:Prognosis; D011857:Radiographic Image Interpretation, Computer-Assisted; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18