Yi Liu, Yushi Peng, Fangansheng Chen, Rui Yao, Ling Wang, Kun Tang
{"title":"18f -2-氟-2-脱氧葡萄糖PET/计算机断层扫描放射组学在表皮生长因子受体突变亚型预测和接受一线表皮生长因子受体酪氨酸激酶抑制剂治疗的晚期肺腺癌患者的无进展生存中的价值。","authors":"Yi Liu, Yushi Peng, Fangansheng Chen, Rui Yao, Ling Wang, Kun Tang","doi":"10.1097/MNM.0000000000002032","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>Epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) improve survival of EGFR-mutated lung adenocarcinoma (LUAD); however, outcomes vary with genetic subtypes and tumor heterogeneity in late-stage. We aimed to construct pretreatment 18 F-2-fluoro-2-deoxyglucose PET/computed tomography ( 18 F-FDG PET/CT) radiomics models for EGFR-subtype prediction and prognosis in first-line TKIs-treated patients.</p><p><strong>Methods: </strong>We retrospectively analyzed 131 EGFR-mutated advanced LUAD patients from 2017 to 2024: 72 exon 19 deletion (19Del) and 59 exon 21 L858R (21L858R) mutations. After feature selection, support vector machine models: PET, CT, PET-CT, and clinical PET-CT combined models were built. Performance was evaluated by areas under the receiver operating characteristic curve (AUC), calibration curves, and decision curve analysis (DCA). Model-derived radscore was used to explore progression-free survival (PFS) in first-line EGFR-TKIs-treated patients. Multivariate Cox regression was conducted to identify independent factors.</p><p><strong>Results: </strong>The clinical PET/CT combined model achieved AUCs of 0.854 [95% confidence interval (CI): 0.776-0.932] and 0.785 (95% CI: 0.639-0.932) in training and test sets. The calibration curves showed good agreement, and the DCA confirmed clinical utility. Among 125 successfully followed patients, 21L858R mutation patients showed poorer median PFS ( P = 0.008) compared to 19Del mutation. High radscore [hazard ratio (HR): 0.57, 95% CI: 0.34-0.94, P = 0.029], third-generation TKI therapy (HR: 0.45, 95% CI: 0.27-0.73, P = 0.001), and high maximum standardized uptake value (HR: 1.67, 95% CI: 1.03-2.69, P = 0.036) were independent factors of PFS.</p><p><strong>Conclusion: </strong>Integrating 18 F-FDG PET/CT radiomics with clinical data precisely identifies EGFR mutation subtypes and guides initial TKI monotherapy in advanced LUAD.</p>","PeriodicalId":19708,"journal":{"name":"Nuclear Medicine Communications","volume":" ","pages":"1069-1077"},"PeriodicalIF":1.3000,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"The value of 18 F-2-fluoro-2-deoxyglucose PET/computed tomography radiomics in epidermal growth factor receptor mutation subtypes prediction and progression-free survival in advanced lung adenocarcinoma patients with first-line epidermal growth factor receptor tyrosine kinase inhibitors therapy.\",\"authors\":\"Yi Liu, Yushi Peng, Fangansheng Chen, Rui Yao, Ling Wang, Kun Tang\",\"doi\":\"10.1097/MNM.0000000000002032\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>Epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) improve survival of EGFR-mutated lung adenocarcinoma (LUAD); however, outcomes vary with genetic subtypes and tumor heterogeneity in late-stage. We aimed to construct pretreatment 18 F-2-fluoro-2-deoxyglucose PET/computed tomography ( 18 F-FDG PET/CT) radiomics models for EGFR-subtype prediction and prognosis in first-line TKIs-treated patients.</p><p><strong>Methods: </strong>We retrospectively analyzed 131 EGFR-mutated advanced LUAD patients from 2017 to 2024: 72 exon 19 deletion (19Del) and 59 exon 21 L858R (21L858R) mutations. After feature selection, support vector machine models: PET, CT, PET-CT, and clinical PET-CT combined models were built. Performance was evaluated by areas under the receiver operating characteristic curve (AUC), calibration curves, and decision curve analysis (DCA). Model-derived radscore was used to explore progression-free survival (PFS) in first-line EGFR-TKIs-treated patients. Multivariate Cox regression was conducted to identify independent factors.</p><p><strong>Results: </strong>The clinical PET/CT combined model achieved AUCs of 0.854 [95% confidence interval (CI): 0.776-0.932] and 0.785 (95% CI: 0.639-0.932) in training and test sets. The calibration curves showed good agreement, and the DCA confirmed clinical utility. Among 125 successfully followed patients, 21L858R mutation patients showed poorer median PFS ( P = 0.008) compared to 19Del mutation. High radscore [hazard ratio (HR): 0.57, 95% CI: 0.34-0.94, P = 0.029], third-generation TKI therapy (HR: 0.45, 95% CI: 0.27-0.73, P = 0.001), and high maximum standardized uptake value (HR: 1.67, 95% CI: 1.03-2.69, P = 0.036) were independent factors of PFS.</p><p><strong>Conclusion: </strong>Integrating 18 F-FDG PET/CT radiomics with clinical data precisely identifies EGFR mutation subtypes and guides initial TKI monotherapy in advanced LUAD.</p>\",\"PeriodicalId\":19708,\"journal\":{\"name\":\"Nuclear Medicine Communications\",\"volume\":\" \",\"pages\":\"1069-1077\"},\"PeriodicalIF\":1.3000,\"publicationDate\":\"2025-11-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Nuclear Medicine Communications\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1097/MNM.0000000000002032\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/7/21 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q3\",\"JCRName\":\"RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Nuclear Medicine Communications","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/MNM.0000000000002032","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/7/21 0:00:00","PubModel":"Epub","JCR":"Q3","JCRName":"RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING","Score":null,"Total":0}
The value of 18 F-2-fluoro-2-deoxyglucose PET/computed tomography radiomics in epidermal growth factor receptor mutation subtypes prediction and progression-free survival in advanced lung adenocarcinoma patients with first-line epidermal growth factor receptor tyrosine kinase inhibitors therapy.
Objective: Epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) improve survival of EGFR-mutated lung adenocarcinoma (LUAD); however, outcomes vary with genetic subtypes and tumor heterogeneity in late-stage. We aimed to construct pretreatment 18 F-2-fluoro-2-deoxyglucose PET/computed tomography ( 18 F-FDG PET/CT) radiomics models for EGFR-subtype prediction and prognosis in first-line TKIs-treated patients.
Methods: We retrospectively analyzed 131 EGFR-mutated advanced LUAD patients from 2017 to 2024: 72 exon 19 deletion (19Del) and 59 exon 21 L858R (21L858R) mutations. After feature selection, support vector machine models: PET, CT, PET-CT, and clinical PET-CT combined models were built. Performance was evaluated by areas under the receiver operating characteristic curve (AUC), calibration curves, and decision curve analysis (DCA). Model-derived radscore was used to explore progression-free survival (PFS) in first-line EGFR-TKIs-treated patients. Multivariate Cox regression was conducted to identify independent factors.
Results: The clinical PET/CT combined model achieved AUCs of 0.854 [95% confidence interval (CI): 0.776-0.932] and 0.785 (95% CI: 0.639-0.932) in training and test sets. The calibration curves showed good agreement, and the DCA confirmed clinical utility. Among 125 successfully followed patients, 21L858R mutation patients showed poorer median PFS ( P = 0.008) compared to 19Del mutation. High radscore [hazard ratio (HR): 0.57, 95% CI: 0.34-0.94, P = 0.029], third-generation TKI therapy (HR: 0.45, 95% CI: 0.27-0.73, P = 0.001), and high maximum standardized uptake value (HR: 1.67, 95% CI: 1.03-2.69, P = 0.036) were independent factors of PFS.
Conclusion: Integrating 18 F-FDG PET/CT radiomics with clinical data precisely identifies EGFR mutation subtypes and guides initial TKI monotherapy in advanced LUAD.
期刊介绍：
Nuclear Medicine Communications, the official journal of the British Nuclear Medicine Society, is a rapid communications journal covering nuclear medicine and molecular imaging with radionuclides, and the basic supporting sciences. As well as clinical research and commentary, manuscripts describing research on preclinical and basic sciences (radiochemistry, radiopharmacy, radiobiology, radiopharmacology, medical physics, computing and engineering, and technical and nursing professions involved in delivering nuclear medicine services) are welcomed, as the journal is intended to be of interest internationally to all members of the many medical and non-medical disciplines involved in nuclear medicine. In addition to papers reporting original studies, frankly written editorials and topical reviews are a regular feature of the journal.
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