Enhancing NSCLC recurrence prediction with PET/CT habitat imaging, ctDNA, and integrative radiogenomics-blood insights

• Published in: Nature communications Vol. 15; no. 1; p. 3152
• Main Authors: Sujit, Sheeba J., Aminu, Muhammad, Karpinets, Tatiana V., Chen, Pingjun, Saad, Maliazurina B., Salehjahromi, Morteza, Boom, John D., Qayati, Mohamed, George, James M., Allen, Haley, Antonoff, Mara B., Hong, Lingzhi, Hu, Xin, Heeke, Simon, Tran, Hai T., Le, Xiuning, Elamin, Yasir Y., Altan, Mehmet, Vokes, Natalie I., Sheshadri, Ajay, Lin, Julie, Zhang, Jianhua, Lu, Yang, Behrens, Carmen, Godoy, Myrna C. B., Wu, Carol C., Chang, Joe Y., Chung, Caroline, Jaffray, David A., Wistuba, Ignacio I., Lee, J. Jack, Vaporciyan, Ara A., Gibbons, Don L., Heymach, John, Zhang, Jianjun, Cascone, Tina, Wu, Jia
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 11.04.2024; Nature Publishing Group; Nature Portfolio
• Subjects: 59/78; 692/4028/67/1612/1350; 692/4028/67/1857; 692/53/2422; Cancer; Carcinoma, Non-Small-Cell Lung - diagnostic imaging; Carcinoma, Non-Small-Cell Lung - genetics; Carcinoma, Non-Small-Cell Lung - metabolism; Computed tomography; Emission analysis; Fluorodeoxyglucose F18; Habitats; Heterogeneity; Humanities and Social Sciences; Humans; Imaging techniques; Lung cancer; Lung diseases; Lung Neoplasms - diagnostic imaging; Lung Neoplasms - genetics; Lung Neoplasms - metabolism; Medical imaging; multidisciplinary; Neoplasm Recurrence, Local - diagnostic imaging; Neoplasm Recurrence, Local - genetics; Neoplasm Recurrence, Local - pathology; Neoplasms; Non-small cell lung carcinoma; Patients; Positron emission; Positron emission tomography; Positron Emission Tomography Computed Tomography - methods; Radiation therapy; Radiopharmaceuticals; Retrospective Studies; Risk factors; Risk levels; Science; Science (multidisciplinary); Small cell lung carcinoma; Tomography; Tomography, X-Ray Computed; Tumors
• ISSN: 2041-1723; 2041-1723
• DOI: 10.1038/s41467-024-47512-0

While we recognize the prognostic importance of clinicopathological measures and circulating tumor DNA (ctDNA), the independent contribution of quantitative image markers to prognosis in non-small cell lung cancer (NSCLC) remains underexplored. In our multi-institutional study of 394 NSCLC patients, we utilize pre-treatment computed tomography (CT) and 18 F-fluorodeoxyglucose positron emission tomography (FDG-PET) to establish a habitat imaging framework for assessing regional heterogeneity within individual tumors. This framework identifies three PET/CT subtypes, which maintain prognostic value after adjusting for clinicopathologic risk factors including tumor volume. Additionally, these subtypes complement ctDNA in predicting disease recurrence. Radiogenomics analysis unveil the molecular underpinnings of these imaging subtypes, highlighting downregulation in interferon alpha and gamma pathways in the high-risk subtype. In summary, our study demonstrates that these habitat imaging subtypes effectively stratify NSCLC patients based on their risk levels for disease recurrence after initial curative surgery or radiotherapy, providing valuable insights for personalized treatment approaches. Predicting recurrence risk in non small cell lung cancer can help to guide treatment decisions. Here, the authors use CT and PET imaging to develop predictive imaging subtypes, which can be integrated with existing ctDNA methods to predict recurrence.