title: Early-Stage Non-Small Cell Lung Cancer: Quantitative Imaging Characteristics of (18)F Fluorodeoxyglucose PET/CT Allow Prediction of Distant Metastasis.
abstract: Purpose To identify quantitative imaging biomarkers at fluorine 18 ((18)F) positron emission tomography (PET) for predicting distant metastasis in patients with early-stage non-small cell lung cancer (NSCLC). Materials and Methods In this institutional review board-approved HIPAA-compliant retrospective study, the pretreatment (18)F fluorodeoxyglucose PET images in 101 patients treated with stereotactic ablative radiation therapy from 2005 to 2013 were analyzed. Data for 70 patients who were treated before 2011 were used for discovery purposes, while data from the remaining 31 patients were used for independent validation. Quantitative PET imaging characteristics including statistical, histogram-related, morphologic, and texture features were analyzed, from which 35 nonredundant and robust features were further evaluated. Cox proportional hazards regression model coupled with the least absolute shrinkage and selection operator was used to predict distant metastasis. Whether histologic type provided complementary value to imaging by combining both in a single prognostic model was also assessed. Results The optimal prognostic model included two image features that allowed quantification of intratumor heterogeneity and peak standardized uptake value. In the independent validation cohort, this model showed a concordance index of 0.71, which was higher than those of the maximum standardized uptake value and tumor volume, with concordance indexes of 0.67 and 0.64, respectively. The prognostic model also allowed separation of groups with low and high risk for developing distant metastasis (hazard ratio, 4.8; P = .0498, log-rank test), which compared favorably with maximum standardized uptake value and tumor volume (hazard ratio, 1.5 and 2.0, respectively; P = .73 and 0.54, log-rank test, respectively). When combined with histologic types, the prognostic power was further improved (hazard ratio, 6.9; P = .0289, log-rank test; and concordance index, 0.80). Conclusion PET imaging characteristics associated with distant metastasis that could potentially help practitioners to tailor appropriate therapy for individual patients with early-stage NSCLC were identified. (©) RSNA, 2016 Online supplemental material is available for this article.
authors.affiliation: From the Department of Radiation Oncology (J.W., T.A., D.S., M.G., B.W.L., M.D., R.L.), Department of Radiology and Medicine (Biomedical Informatics Research) (D.L.R.), Stanford Cancer Institute (B.W.L., M.D., R.L.), and Institute for Stem Cell Biology and Regenerative Medicine (M.D.), Stanford University School of Medicine, 1070 Arastradero Rd, Palo Alto, CA 94304.
authors.forename: Jia
authors.initials: J
authors.lastname: Wu
authors.affiliation: From the Department of Radiation Oncology (J.W., T.A., D.S., M.G., B.W.L., M.D., R.L.), Department of Radiology and Medicine (Biomedical Informatics Research) (D.L.R.), Stanford Cancer Institute (B.W.L., M.D., R.L.), and Institute for Stem Cell Biology and Regenerative Medicine (M.D.), Stanford University School of Medicine, 1070 Arastradero Rd, Palo Alto, CA 94304.
authors.forename: Todd
authors.initials: T
authors.lastname: Aguilera
authors.affiliation: From the Department of Radiation Oncology (J.W., T.A., D.S., M.G., B.W.L., M.D., R.L.), Department of Radiology and Medicine (Biomedical Informatics Research) (D.L.R.), Stanford Cancer Institute (B.W.L., M.D., R.L.), and Institute for Stem Cell Biology and Regenerative Medicine (M.D.), Stanford University School of Medicine, 1070 Arastradero Rd, Palo Alto, CA 94304.
authors.forename: David
authors.initials: D
authors.lastname: Shultz
authors.affiliation: From the Department of Radiation Oncology (J.W., T.A., D.S., M.G., B.W.L., M.D., R.L.), Department of Radiology and Medicine (Biomedical Informatics Research) (D.L.R.), Stanford Cancer Institute (B.W.L., M.D., R.L.), and Institute for Stem Cell Biology and Regenerative Medicine (M.D.), Stanford University School of Medicine, 1070 Arastradero Rd, Palo Alto, CA 94304.
authors.forename: Madhu
authors.initials: M
authors.lastname: Gudur
authors.affiliation: From the Department of Radiation Oncology (J.W., T.A., D.S., M.G., B.W.L., M.D., R.L.), Department of Radiology and Medicine (Biomedical Informatics Research) (D.L.R.), Stanford Cancer Institute (B.W.L., M.D., R.L.), and Institute for Stem Cell Biology and Regenerative Medicine (M.D.), Stanford University School of Medicine, 1070 Arastradero Rd, Palo Alto, CA 94304.
authors.forename: Daniel L
authors.initials: DL
authors.lastname: Rubin
authors.affiliation: From the Department of Radiation Oncology (J.W., T.A., D.S., M.G., B.W.L., M.D., R.L.), Department of Radiology and Medicine (Biomedical Informatics Research) (D.L.R.), Stanford Cancer Institute (B.W.L., M.D., R.L.), and Institute for Stem Cell Biology and Regenerative Medicine (M.D.), Stanford University School of Medicine, 1070 Arastradero Rd, Palo Alto, CA 94304.
authors.forename: Billy W
authors.initials: BW
authors.lastname: Loo
authors.affiliation: From the Department of Radiation Oncology (J.W., T.A., D.S., M.G., B.W.L., M.D., R.L.), Department of Radiology and Medicine (Biomedical Informatics Research) (D.L.R.), Stanford Cancer Institute (B.W.L., M.D., R.L.), and Institute for Stem Cell Biology and Regenerative Medicine (M.D.), Stanford University School of Medicine, 1070 Arastradero Rd, Palo Alto, CA 94304.
authors.forename: Maximilian
authors.initials: M
authors.lastname: Diehn
authors.affiliation: From the Department of Radiation Oncology (J.W., T.A., D.S., M.G., B.W.L., M.D., R.L.), Department of Radiology and Medicine (Biomedical Informatics Research) (D.L.R.), Stanford Cancer Institute (B.W.L., M.D., R.L.), and Institute for Stem Cell Biology and Regenerative Medicine (M.D.), Stanford University School of Medicine, 1070 Arastradero Rd, Palo Alto, CA 94304.
authors.forename: Ruijiang
authors.initials: R
authors.lastname: Li
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor; D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000532:radiotherapy; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000532:radiotherapy; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D000072078:Positron Emission Tomography Computed Tomography; D011237:Predictive Value of Tests; D019275:Radiopharmaceuticals; D012189:Retrospective Studies
chemical_list: D014408:Biomarkers, Tumor; D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18