Noninvasive imaging evaluation of tumor immune microenvironment to predict outcomes in gastric cancer
Noninvasive imaging evaluation of tumor immune microenvironment to predict outcomes in gastric cancer
复制标题
肿瘤免疫微环境的无创影像学评价预测胃癌预后
DOI：
10.1016/j.annonc.2020.03.295
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发表时间：
2020-06-01
影响因子：
50.5
通讯作者：
Li, R.
中科院分区：
文献类型：
--
作者：
Jiang, Y.;Wang, H.;Li, R.
背景：肿瘤免疫微环境可提供预后和预测信息。先前验证的胃癌免疫评分（ISGC）通过手术标本的免疫组织化学染色评估肿瘤核心和侵袭性边缘的淋巴细胞和髓细胞。我们的目标是开发一种基于无创放射学的ISGC预测器。患者和方法：在这项回顾性研究中，包括四个独立的队列，共1778名患者，我们从对比增强计算机断层扫描图像上提取了584个肿瘤内和肿瘤周围区域的定量特征。构建放射组学特征[放射组学免疫评分（RIS）]，使用正则化逻辑回归预测ISGC。我们进一步评估其与预后和化疗反应的关系。结果：在三个独立的队列（曲线下面积0.786,0.745和0.766）中建立了13个特征的ISGC放射特征并进行了验证。RIS特征与训练组和所有验证组的无病生存和总生存均显著相关[风险比（HR）范围：0.296-0.487，均P < 0.001]。在多变量分析中，RIS仍然是一个独立的影响临床病理变量的预后因素（调整后的HR范围：0.339-0.605，均P < 0.003）。对于H期和III期疾病，高RIS衍生生存获益的患者从辅助化疗中获益{HR = 0.436[95%可信区间（CI） 0.253-0.753], P = 0.002；HR = 0.591 (95% CI 0.428-0.818, P < 0.001)，而RIS较低的患者则没有。结论：RIS是评价胃癌免疫评分的可靠工具，对胃癌预后具有重要意义。未来的前瞻性研究需要证实其预测治疗反应的潜力，并选择将从化疗中受益的患者。
Background: The tumor immune microenvironment can provide prognostic and predictive information. A previously validated ImmunoScore of Gastric Cancer (ISGC) evaluates both lymphoid and myeloid cells in the tumor core and invasive margin with immunohistochemical staining of surgical specimens. We aimed to develop a noninvasive radiomics-based predictor of ISGC.Patients and methods: In this retrospective study including four independent cohorts of 1778 patients, we extracted 584 quantitative features from the intratumoral and peritumoral regions on contrast-enhanced computed tomography images. A radiomic signature [radiomics ImmunoScore (RIS)] was constructed to predict ISGC using regularized logistic regression. We further evaluated its association with prognosis and chemotherapy response.Results: A 13-feature radiomic signature for ISGC was developed and validated in three independent cohorts (area under the curve 0.786, 0.745, and 0.766). The RIS signature was significantly associated with both disease-free and overall survival in the training and all validation cohorts [hazard ratio (HR) range: 0.296-0.487, all P < 0.001]. In multivariable analysis, the RIS remained an independent prognostic factor adjusting for clinicopathologic variables (adjusted HR range: 0.339-0.605, all P < 0.003). For stage H and stage III disease, patients with a high RIS derived survival benefit from adjuvant chemotherapy {HR = 0.436 [95% confidence interval (CI) 0.253-0.753], P = 0.002; HR = 0.591 (95% CI 0.428-0.818), P < 0.001, respectively), whereas those with a low RIS did not.Conclusion: The RIS is a reliable tool for evaluation of immunoscore and retains the prognostic significance in gastric cancer. Future prospective studies are required to confirm its potential to predict treatment response and select patients who will benefit from chemotherapy.