Development and validation of a prognostic model incorporating texture analysis derived from standardised segmentation of pet in patients with oesophageal cancer
Foley K., Hills RK., Berthon B., Marshall C., Parkinson C., Lewis WG., Crosby TDL., Spezi E., Roberts SA.
Objectives This retrospective cohort study developed a prognostic model incorporating PET texture analysis in patients with oesophageal cancer (OC). Internal validation of the model was performed. Methods Consecutive OC patients (n = 403) were chronologically separated into development (n = 302, September 2010-September 2014, median age = 67.0, males = 227, adenocarcinomas = 237) and validation cohorts (n = 101, September 2014-July 2015, median age = 69.0, males = 78, adenocarcinomas = 79). Texture metrics were obtained using a machine-learning algorithm for automatic PET segmentation. A Cox regression model including age, radiological stage, treatment and 16 texture metrics was developed. Patients were stratified into quartiles according to a prognostic score derived from the model. A p-value \ensuremath< 0.05 was considered statistically significant. Primary outcome was overall survival (OS). Results Six variables were significantly and independently associated with OS: age [HR =1.02 (95% CI 1.01-1.04), p \ensuremath< 0.001], radiological stage [1.49 (1.20-1.84), p \ensuremath< 0.001], treatment [0.34 (0.24?0.47), p \ensuremath< 0.001], log(TLG) [5.74 (1.44?22.83), p = 0.013], log(Histogram Energy) [0.27 (0.10?0.74), p = 0.011] and Histogram Kurtosis [1.22 (1.04?1.44), p = 0.017]. The prognostic score demonstrated significant differences in OS between quartiles in both the development (X2 143.14, df 3, p \ensuremath< 0.001) and validation cohorts (X2 20.621, df 3, p \ensuremath< 0.001). Conclusions This prognostic model can risk stratify patients and demonstrates the additional benefit of PET texture analysis in OC staging.