Prognostic Value of Computed Tomography Texture Features in Non-Small Cell Lung Cancers Treated With Definitive Concomitant Chemoradiotherapy

Objectives The aim of this study was to investigate whether the computed tomography (CT) texture features of primary tumors are associated with the overall survival (OS) of non-small cell lung cancer (NSCLC) patients undergoing definitive concomitant chemoradiotherapy (CCRT). Materials and Methods In this retrospective study, 98 patients (83 men and 15 women; mean age, 61.9 8.0 years) with unresectable NSCLCs (stage IIIA, 45; stage IIIB, 53) underwent definitive CCRT at our institution from January 2006 to December 2011. Patients were followed up for 3 years or until death. The CT texture parameters of primary tumors were extracted from contrast-enhanced CT images taken before CCRT using an in-house software program. Each texture parameter was dichotomized based on their optimal cutoff values obtained from receiver operating characteristics curve analysis. Three-year OS was compared between the dichotomized subgroups using Kaplan-Meier analysis and the log-rank test. Multivariate Cox regression analysis was performed to determine significant prognostic factors. Results The 3-year cumulative survival rate was 0.51. The mean 3-year OS was 24.0 months (95% confidence interval, 21.5-26.6 months). There were no significant differences in 3-year OS according to tumor stage or histologic subtypes. However, entropy (P = 0.030), skewness (P = 0.021), and mean attenuation (P = 0.030) were shown to be significantly associated with 3-year OS. Multivariate Cox regression analysis revealed that higher entropy (adjusted hazard ratio [HR],2.31; P = 0.040), higher skewness (adjusted HR,1.92; P = 0.046), and higher mean attenuation (adjusted HR,1.93; P = 0.028) were independent predictors of decreased 3-year OS. Conclusions Computed tomography texture features have the potential to be used as prognostic biomarkers in unresectable NSCLC patients undergoing definitive CCRT.