基于胸部增强CT影像组学评估培美曲塞二钠+铂类对晚期肺腺癌化疗疗效的可行性分析

Evaluating the Curative Effect of Pemetrexed Disodium + Platinum forAdvanced Lung Adenocarcinoma Chemotherapy Based onChest Enhanced CT Radiomics:A Feasibility Study

目的 探究基于晚期肺腺癌患者治疗前胸部增强CT图像构建的影像组学模型预测培美曲塞二钠+铂类化疗疗效的可行性。方法 回顾性搜集本院2018年1月至2022年11月经穿刺病理确诊仅选取培美曲塞二钠+铂类化疗的131例肺腺癌患者的临床及增强CT资料,按照7∶3的比例分层抽样法将病例分为训练集92例和测试集39例。根据实体肿瘤疗效评价标准(RECIST),将患者分为缓解组68例,未缓解组63例。提取并筛选治疗前CT图像的组学特征,并基于最终特征值采用支持向量机(SVM)、逻辑回归(LR)及高斯过程(GP)三种分类器构建影像组学模型。采用受试者工作特征曲线(ROC)和决策曲线分析(DCA)评估比较三种模型的预测能力、诊断效能及临床应用价值。结果 三种模型训练集曲线下面积(AUC)分别为0.821、0.812、0.827,测试集AUC分别为0.664、0.714、0.709,差异没有统计学意义;DCA示GP及SVM的净收益均高于LR;而训练集及测试集中GP及SVM的净收益无明显区别。结论 基于胸部增强CT的影像组学模型对培美曲塞二钠+铂类治疗晚期肺腺癌患者的化疗疗效具有可行性,且GP及SVM在一定阈值范围内临床净收益优于LR。

Objective To explore the feasibility of predicting the efficacy of pemetrexed disodium plus platinum chemo⁃therapy based on chest enhanced CT images of patients with advanced lung adenocarcinoma before treatment.Methods The clinical and enhanced CT data of 131 patients with lung adenocarcinoma diagnosed by puncture pathology in our hospi⁃tal from January 2018 to November 2022 were collected retrospectively.The patients were divided into training group(n=92)and test group(n=39)according to 7∶3 proportional sampling method.According to RECIST criteria,the patients were divided into remission group(n=68)and non⁃remission group(n=63).The combinatorial features of CT images before treatment were extracted and screened,and based on the final eigenvalues,support vector machine(support vector machine,SVM),logical regression(logistic regression,LR)and Gaussian process(Gaussian process,GP)classifiers were used to construct the imaging model.The predictive ability,diagnostic efficiency and clinical application value of the three models were analyzed and compared by subject working characteristic curve and decision curve.Results The AUC of the training set of the three models was 0.821,0.812 and 0.827,and the AUC of the test set was 0.664,0.714 and 0.709 re⁃spectively,the difference was not statistically significant,and the decision curve analysis showed that the net income of GP and SVM was higher than that of LR;while there was no significant difference between the training set and the test set of GP and SVM.Conclusion The imaging model based on chest enhanced CT is feasible for pemetrexed disodium plus platinum in the treatment of advanced lung adenocarcinoma,and the clinical net benefit of GP and SVM is better than that of LR within a certain threshold.