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SUVmax to tumor perimeter distance: a robust radiomics prognostic biomarker in resectable non-small cell lung cancer patients

  • Nuclear Medicine
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objective

The purpose of this study was to evaluate the prognostic value of novel geometric variables obtained from pre-treatment [18F]FDG PET/CT with respect to classical ones in patients with non-small cell lung cancer (NSCLC).

Methods

Retrospective study including stage I–III NSCLC patients with baseline [18F]FDG PET/CT. Clinical, histopathologic, and metabolic parameters were obtained. After tumor segmentation, SUV and volume-based variables, global texture, sphericity, and two novel parameters, normalized SUVpeak to centroid distance (nSCD) and normalized SUVmax to perimeter distance (nSPD), were obtained. Early recurrence (ER) and short-term mortality (STM) were used as end points. Univariate logistic regression and multivariate logistic regression with respect to ER and STM were performed.

Results

A cohort of 173 patients was selected. ER was detected in 49/104 of patients with recurrent disease. Additionally, 100 patients died and 53 had STM. Age, pathologic lymphovascular invasion, lymph nodal infiltration, TNM stage, nSCD, and nSPD were associated with ER, although only age (aOR = 1.06, p = 0.002), pathologic lymphovascular invasion (aOR = 3.40, p = 0.022), and nSPD (aOR = 0.02, p = 0.018) were significant independent predictors of ER in multivariate analysis. Age, lymph nodal infiltration, TNM stage, nSCD, and nSPD were predictors of STM. Age (aOR = 1.05, p = 0.006), lymph nodal infiltration (aOR = 2.72, p = 0.005), and nSPD (aOR = 0.03, p = 0.022) were significantly associated with STM in multivariate analysis. Coefficient of variation (COV) and SUVmean/SUVmax ratio did not show significant predictive value with respect to ER or STM.

Conclusion

The geometric variables, nSCD and nSPD, are robust biomarkers of the poorest outcome prediction of patients with NSCLC with respect to classical PET variables.

Key Points

• In NSCLC patients, it is crucial to find prognostic parameters since TNM system alone cannot explain the variation in lung cancer survival.

• Age, lymphovascular invasion, lymph nodal infiltration, and metabolic geometrical parameters were useful as prognostic parameters.

• The displacement grade of the highest point of metabolic activity towards the periphery assessed by geometric variables obtained from [18F]FDG PET/CT was a robust biomarker of the poorest outcome prediction of patients with NSCLC.

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Abbreviations

Ach:

Adjuvant chemotherapy

ADC:

Adenocarcinoma

aOR:

Adjusted odds ratio

CCI:

Charlson Comorbidity Index

COV:

Coefficient of variation

DFS:

Disease-free survival

ER:

Early recurrence

MTV:

Metabolic tumor volume

NSCLC:

Non-small cell lung carcinoma

OR:

Odds ratio

OS:

Overall survival

PORT:

Postoperative radiotherapy

SCC:

Squamous cell carcinoma

STM:

Short-term mortality

SUV:

Standardized uptake value

TLG:

Total lesion glycolysis

TNM:

Tumor node metastasis

VOI:

Volume of interest

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Authors and Affiliations

  1. Department of Nuclear Medicine, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain

    Germán Andrés Jiménez Londoño, Ana Maria García Vicente & Ángel María Soriano Castrejón

  2. Department of Mathematics, Mathematical Oncology Laboratory (MOLAB), Universidad de Castilla-La Mancha, Ciudad Real, Spain

    Jesús J. Bosque, Julián Pérez-Beteta & Víctor M. Pérez-García

  3. Department of Mathematics, Universidad de Castilla-La Mancha, Ciudad Real, Spain

    Mariano Amo-Salas

  4. Department of Surgery, Hospital General Universitario de Albacete, Albacete, Spain

    Antonio Francisco Honguero-Martinez

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  1. Germán Andrés Jiménez Londoño
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Correspondence to Germán Andrés Jiménez Londoño.

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Jiménez Londoño, G.A., García Vicente, A.M., Bosque, J.J. et al. SUVmax to tumor perimeter distance: a robust radiomics prognostic biomarker in resectable non-small cell lung cancer patients. Eur Radiol 32, 3889–3902 (2022). https://doi.org/10.1007/s00330-021-08523-3

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