Baseline 18F-FDG PET/CT Radiomics Combined Clinical And Dissemination Features Could Predict Interim Respons And Prognosis In DLBCL

Objectives:1.We evaluated whether the baseline 18F-fluorodeoxyglucose positron emission tomography/computed tomography(18F-FDG PET/CT)radiomics features could predicted the interim treatment response with diffuse large B-cell lymphoma(DLBCL)treated with R-CHOP or R-CHOP-like Chemotherapy.2.This study evaluated the value of baseline 18F-FDG PET/CT radiomics features,clinical parameters,and semi-quantitative PET parameters for prognostic stratification of 2-year progression-free survival in DLBCL patients treated with first-line R-CHOP or R-CHOP-like chemotherapy,and to further evaluate the potential prognostic significance of lymphoma dissemination features(Dmax).Material and methods:The baseline data of 102 patients with DLBCL who underwent 18F-FDG PET/CT scan before chemotherapy were finally diagnosed by pathology were retrospectively analyzed.Binary Logistic regression models were used to analyze the relationship between these parameters and interim efficacy.Kaplan-Meier survival analysis and Cox regression model were used to analyze 2-year progression-free survival(2y-PFS).A prognostic stratification model was established based on independent risk factors in Cox regression analysis.For each newly diagnosed DLBCL patient,we extracted 70 radiomics features,4 PET semi-quantitative parameters(SUVmax,SUVmean,MTV,TLG)and the dissemination features of the lesions(defined as the maximum geometric distance between lymphoma lesions)extracted from each patient’s baseline 18F-FDG PET/CT images using the LIFEX software(V.6.30,http://www.lifexsoft.org).The least absolute shrinkage and selection operator(LASSO)algorithm was used to select the radiomics features and finally calculate the Rad-score.Binary Logistic regression model was used to analyze and screen the parameters related to the mid-term efficacy of treatment.Based on these characteristics,a stratified model of medium-term efficacy of lymphoma patients was constructed.The receiver operating characteristic curve(ROC)was used to compare the predictive performance of the models based on radiomics features,clinical variables and their combinations.In addition,Cox proportional-hazards regression was used to identify factors for 2-year progression-free survival outcomes and to calculate hazard ratios(HR)with 95% confidence intervals.Results:1.According to the ROC analysis of baseline 18F-FDG PET/CT radiomics features,a total of 6 18F-FDG PET/CT radiomics features significantly associated with DLBCL treatment interim response(DISCRETIZED＿SUVbwmax;DISCRETIZEDSUVbw＿Excess Kurtosis;DISCRETIZED-SUVbw Kurtosis;SHAPE＿Sphericity＿only For＿3DROI;GLZLM-SZE;GLZLM-GLNU),these were used to construct interim radiomics scores.The radiomics rad-score showed a significant ability to distinguish complete response and non-complete response(CR/ non-CR)in both the training and testing sets(P < 0.001,P < 0.05),and the area under the ROC curve(AUC)was 0.823[95%CI(0.688-0.885)] in the training set.0.805 [95%CI(0.719-0.890)] in the testing set.2.Six baseline 18F-FDG PET/CT radiomics features(DISCRETIZED SUVbw Kurtosis,SHAPE＿Sphericity.only For＿3DROI,GLZLM ZLNU,GLZLM GLNU,Shape＿sphericity.NGLDM Coarseness,GLZLM SZHGE)associated with 2-year progression-free survival of DLBCL were screened constructed the prognostic radiomics score RS(Rad-score).The area under the ROC curve(AUC)of the prognostic radiomics score in the training set was 0.752 [95%CI(0.688-0.885)] and 0.729 [95%CI(0.719-0.890)] in the testing set.In addition,Cox proportional hazards regression was used to determine the factors for 2-year progression-free survival outcome and to calculate the hazard ratio(HR)and 95% CI.MTV,Dmax and Rad-score were associated with 2-year progression-free survival of DLBCL.Conclusion:(1)The radiomics features of baseline 18F-FDG PET/CT can be used as predictors of interim response in DLBCL,and the combined model with clinical parameters has a higher diagnostic efficiency in predicting interim response.(2)The prognostic radiomics score RS,metabolic tumor volume MTV and lymphoma dissemination features Dmax were prognostic factors for 2-year PFS of DLBCL,and Rad-score model was superior to the international prognostic index(IPI)model.(3)Six baseline 18F-FDG PET/CT radiomics features(DISCRETIZED SUVbw＿Kurtosis,SHAPE＿Sphericity.only＿For＿3DROI,GLZLM ZLNU,GLZLM GLNU,Shape＿sphericity.NGLDM Coarseness,GLZLM SZHGE)were associated with 2-year PFS of DLBCL.This study provided an early response and prognostic stratification model,which may be useful in guiding risk-adapted treatment strategies for DLBCL patients in clinical practice.