Prognostic and predictive value of histogram analysis in patients with non-small cell lung cancer refractory to platinum treated by nivolumab: A multicentre retrospective study

Marco Ravanelli; Giorgio Maria Agazzi; Gianluca Milanese; Elisa Roca; Mario Silva; Marcello Tiseo; Paolo Rondi; Alice Baggi; Balaji Ganeshan; Margherita Muri; Stefano Panni; Camilla Botti; Nicola Sverzellati; Roberto Maroldi; Alfredo Berruti; Davide Farina

doi:10.1016/j.ejrad.2019.07.019

Prognostic and predictive value of histogram analysis in patients with non-small cell lung cancer refractory to platinum treated by nivolumab: A multicentre retrospective study

Eur J Radiol. 2019 Sep:118:251-256. doi: 10.1016/j.ejrad.2019.07.019. Epub 2019 Jul 17.

Authors

Marco Ravanelli¹, Giorgio Maria Agazzi², Gianluca Milanese³, Elisa Roca⁴, Mario Silva⁵, Marcello Tiseo⁶, Paolo Rondi⁷, Alice Baggi⁸, Balaji Ganeshan⁹, Margherita Muri¹⁰, Stefano Panni¹¹, Camilla Botti¹², Nicola Sverzellati¹³, Roberto Maroldi¹⁴, Alfredo Berruti¹⁵, Davide Farina¹⁶

Affiliations

¹ University of Brescia, Department of Radiology, P.le Spedali Civili 1, 25123, Brescia, Italy. Electronic address: marcoravanelli@hotmail.it.
² University of Brescia, Department of Radiology, P.le Spedali Civili 1, 25123, Brescia, Italy. Electronic address: giorgiomaria.agazzi@gmail.com.
³ University of Parma, Department of Radiology, via Università, 12, I 43121, Parma, Italy. Electronic address: gianluca.milanese@studenti.unipr.it.
⁴ University of Brescia, Department of Oncology, P.le Spedali Civili 1, 25123, Brescia, Italy. Electronic address: elisaroca@gmail.com.
⁵ University of Parma, Department of Radiology, via Università, 12, I 43121, Parma, Italy. Electronic address: mario.silva@unipr.it.
⁶ Department of Medicine and Surgery, University of Parma and Medical Oncology Unit, University Hospital of Parma, Italy. Electronic address: mtiseo@ao.pr.it.
⁷ University of Brescia, Department of Oncology, P.le Spedali Civili 1, 25123, Brescia, Italy. Electronic address: paolo.rondi92@gmail.com.
⁸ University of Brescia, Department of Oncology, P.le Spedali Civili 1, 25123, Brescia, Italy. Electronic address: a.baggi001@studenti.unibs.it.
⁹ University College London, Institute of Nuclear Medicine, Gower Street, London, United Kingdom. Electronic address: b.ganeshan@ucl.ac.uk.
¹⁰ ASST Cremona, Department of Radiology, Viale Concordia n 1, 26100, Cremona, Italy. Electronic address: margheritamuri@gmail.com.
¹¹ ASST Cremona, Department of Oncology Italy. Electronic address: stefanopanni@alice.it.
¹² University of Brescia, Department of Radiology, P.le Spedali Civili 1, 25123, Brescia, Italy. Electronic address: botti.camilla@gmail.com.
¹³ University of Parma, Department of Radiology, via Università, 12, I 43121, Parma, Italy. Electronic address: nicola.sverzellati@unipr.it.
¹⁴ University of Brescia, Department of Radiology, P.le Spedali Civili 1, 25123, Brescia, Italy. Electronic address: roberto.maroldi@unibs.it.
¹⁵ University of Brescia, Department of Oncology, P.le Spedali Civili 1, 25123, Brescia, Italy. Electronic address: alfredo.berruti@unibs.it.
¹⁶ University of Brescia, Department of Radiology, P.le Spedali Civili 1, 25123, Brescia, Italy. Electronic address: davide.farina@unibs.it.

PMID: 31439251
DOI: 10.1016/j.ejrad.2019.07.019

Abstract

Purpose: The aim of this study was to assess computed-tomography histogram analysis (CTHA) as prognostic and predictive factor in platinum-refractory non-small cell lung carcinoma (NSCLC) treated with immune checkpoint inhibitor Nivolumab.

Method: One hundred and four patients were enrolled from 3 different centers. CT was performed using similar parameters among different scanners. CTHA was performed with the proprietary software TexRAD, which extracts histogram features at different spatial scale (spatial scale filters, SSF) producing 30 CTHA features per patients. Cross-validated Least Absolute Shrinkage and Selection Operator LASSO was used to select those features which were related to overall and progression-free survival (OS and PFS, respectively). High- and low-risk subgroups were identified using the best cutoff.

Results: Median follow-up was 13.8 weeks. Median OS and PFS were 7.3 and 3 months, respectively. LASSO selected kurtosis obtained by SSF = 4 mm as the single feature related to OS, leading to an hazard ratio (HR) of 0.476 (95%CI 0.29-0.77). PFS was related with kurtosis SSF = 6 mm, with HR of 0.556 (95%CI 0.36-0.86).

Conclusion: Despite its limitations, this study is the first which suggests that CTHA could play a role in stratifying prognosis and treatment response in patients with NSCLC treated with Nivolumab.

Keywords: Histogram analysis, iRECIST; Immunotherapy; Lung neoplasms; Neoplasms/diagnostic imaging; Nivolumab; Tomography, X-Ray computed.

Publication types

Multicenter Study

MeSH terms

Adult
Aged
Aged, 80 and over
Antineoplastic Agents, Immunological / therapeutic use*
Carcinoma, Non-Small-Cell Lung / diagnostic imaging
Carcinoma, Non-Small-Cell Lung / drug therapy*
Carcinoma, Non-Small-Cell Lung / mortality
Disease-Free Survival
Drug Resistance, Neoplasm
Female
Humans
Lung Neoplasms / diagnostic imaging
Lung Neoplasms / drug therapy*
Lung Neoplasms / mortality
Male
Middle Aged
Nivolumab / therapeutic use*
Platinum Compounds / therapeutic use
Prognosis
Proportional Hazards Models
Retrospective Studies
Tomography, X-Ray Computed / methods
Treatment Outcome

Substances

Antineoplastic Agents, Immunological
Platinum Compounds
Nivolumab