■通过量化来自治疗前CT图像的瘤内异质性,研究接受新辅助免疫化疗(NAIC)的非小细胞肺癌(NSCLC)患者的病理完全缓解(pCR)的预测。
■这项回顾性研究包括在4个不同中心接受NAIC的178例NSCLC患者。训练组包括来自A中心的108名患者,而外部验证集由来自中心B的70名患者组成,中心C,和中心D.传统的影像组学模型使用影像组学特征进行了对比。提取感兴趣的肿瘤区域(ROI)内的每个像素的影像组学特征。使用K均值无监督聚类方法确定肿瘤子区域的最佳划分。使用来自每个肿瘤子区域的生境特征开发了内部肿瘤异质性生境模型。本研究采用LR算法构建机器学习预测模型。使用诸如受试者工作特征曲线下面积(AUC)等标准评估模型的诊断性能,准确度,特异性,灵敏度,阳性预测值(PPV),和阴性预测值(NPV)。
■在培训队列中,传统的影像组学模型的AUC为0.778[95%置信区间(CI):0.688-0.868],而肿瘤内部异质性生境模型的AUC为0.861(95%CI:0.789-0.932)。肿瘤内部异质性生境模型表现出更高的AUC值。它显示了0.815的准确性,超过了传统的影像组学模型所达到的0.685的准确性。在外部验证队列中,两个模型的AUC值分别为0.723(CI:0.591-0.855)和0.781(95%CI:0.673-0.889),分别。生境模型继续表现出更高的AUC值。在准确性评估方面,肿瘤异质性生境模型优于传统的影像组学模型,与0.686相比,得分为0.743。
■使用CT对接受NAIC的NSCLC患者的肿瘤内异质性进行定量分析以预测pCR,有可能为可切除的NSCLC患者的临床决策提供信息。防止过度治疗,并实现个性化和精确的癌症管理。
UNASSIGNED: To investigate the prediction of pathologic complete response (pCR) in patients with non-small cell lung cancer (NSCLC) undergoing neoadjuvant immunochemotherapy (NAIC) using quantification of intratumoral heterogeneity from pre-treatment CT image.
UNASSIGNED: This retrospective study included 178 patients with NSCLC who underwent NAIC at 4 different centers. The training set comprised 108 patients from center A, while the external validation set consisted of 70 patients from center B, center C, and center D. The traditional radiomics model was contrasted using radiomics features. The radiomics features of each pixel within the tumor region of interest (ROI) were extracted. The optimal division of tumor subregions was determined using the K-means unsupervised clustering method. The internal tumor heterogeneity habitat model was developed using the habitats features from each tumor sub-region. The LR algorithm was employed in this study to construct a machine learning prediction model. The diagnostic performance of the model was evaluated using criteria such as area under the receiver operating characteristic curve (AUC), accuracy, specificity, sensitivity, positive predictive value (PPV), and negative predictive value (NPV).
UNASSIGNED: In the training cohort, the traditional radiomics model achieved an AUC of 0.778 [95% confidence interval (CI): 0.688-0.868], while the tumor internal heterogeneity habitat model achieved an AUC of 0.861 (95% CI: 0.789-0.932). The tumor internal heterogeneity habitat model exhibits a higher AUC value. It demonstrates an accuracy of 0.815, surpassing the accuracy of 0.685 achieved by traditional radiomics models. In the external validation cohort, the AUC values of the two models were 0.723 (CI: 0.591-0.855) and 0.781 (95% CI: 0.673-0.889), respectively. The habitat model continues to exhibit higher AUC values. In terms of accuracy evaluation, the tumor heterogeneity habitat model outperforms the traditional radiomics model, achieving a score of 0.743 compared to 0.686.
UNASSIGNED: The quantitative analysis of intratumoral heterogeneity using CT to predict pCR in NSCLC patients undergoing NAIC holds the potential to inform clinical decision-making for resectable NSCLC patients, prevent overtreatment, and enable personalized and precise cancer management.