F-fluorodeoxyglucose positron emission tomography/computed tomography-based radiomic features for prediction of epidermal growth factor receptor mutation status and prognosis in patients with lung adenocarcinoma.

Background: To investigate whether radiomic features from (F)-fluorodeoxyglucose positron emission tomography/computed tomography [(F)-FDG PET/CT] can predict epidermal growth factor receptor () mutation status and prognosis in patients with lung adenocarcinoma.

Methods: One hundred and seventy-four consecutive patients with lung adenocarcinoma underwent (F)-FDG PET/CT and gene testing were retrospectively analyzed. Radiomic features combined with clinicopathological factors to construct a random forest (RF) model to identify mutation status. The mutant/wild-type model was trained on a training group (n=139) and validated in an independent validation group (n=35). The second RF classifier predicting the 19/21 mutation site was also built and evaluated in an mutation subset (training group, n=80; validation group, n=25). Radiomic score and 5 clinicopathological factors were integrated into a multivariate Cox proportional hazard (CPH) model for predicting overall survival (OS). AUC (the area under the receiver characteristic curve) and C-index were calculated to evaluate the model's performance.

Results: Of 174 patients, 109 (62.6%) harbored mutations, 21L858R was the most common mutation type [55.9% (61/109)]. The mutant/wild-type model was identified in the training (AUC, 0.77) and validation (AUC, 0.71) groups. The 19/21 mutation site model had an AUC of 0.82 and 0.73 in the training and validation groups, respectively. The C-index of the CPH model was 0.757. The survival time between targeted therapy and chemotherapy for patients with mutations was significantly different (P=0.03).

Conclusions: Radiomic features based on (F)-FDG PET/CT combined with clinicopathological factors could reflect genetic differences and predict mutation type and prognosis.