Quantification of preexisting lung ground glass opacities on CT for predicting checkpoint inhibitor pneumonitis in advanced non-small cell lung cancer patients
Abstract Background Immune checkpoint inhibitors (ICIs) can lead to life-threatening pneumonitis, and pre-existing interstitial lung abnormalities (ILAs) are a risk factor for checkpoint inhibitor pneumonitis (CIP). However, the subjective assessment of ILA and the lack of standardized methods restr...
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| Format: | Article |
| Language: | English |
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BMC
2024-02-01
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| Series: | BMC Cancer |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12885-024-12008-z |
| _version_ | 1827327169265664000 |
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| author | Xinyue Wang Jinkun Zhao Ting Mei Wenting Liu Xiuqiong Chen Jingya Wang Richeng Jiang Zhaoxiang Ye Dingzhi Huang |
| author_facet | Xinyue Wang Jinkun Zhao Ting Mei Wenting Liu Xiuqiong Chen Jingya Wang Richeng Jiang Zhaoxiang Ye Dingzhi Huang |
| author_sort | Xinyue Wang |
| collection | DOAJ |
| description | Abstract Background Immune checkpoint inhibitors (ICIs) can lead to life-threatening pneumonitis, and pre-existing interstitial lung abnormalities (ILAs) are a risk factor for checkpoint inhibitor pneumonitis (CIP). However, the subjective assessment of ILA and the lack of standardized methods restrict its clinical utility as a predictive factor. This study aims to identify non-small cell lung cancer (NSCLC) patients at high risk of CIP using quantitative imaging. Methods This cohort study involved 206 cases in the training set and 111 cases in the validation set. It included locally advanced or metastatic NSCLC patients who underwent ICI therapy. A deep learning algorithm labeled the interstitial lesions and computed their volume. Two predictive models were developed to predict the probability of grade ≥ 2 CIP or severe CIP (grade ≥ 3). Cox proportional hazard models were employed to analyze predictors of progression-free survival (PFS). Results In a training cohort of 206 patients, 21.4% experienced CIP. Two models were developed to predict the probability of CIP based on different predictors. Model 1 utilized age, histology, and preexisting ground glass opacity (GGO) percentage of the whole lung to predict grade ≥ 2 CIP, while Model 2 used histology and GGO percentage in the right lower lung to predict grade ≥ 3 CIP. These models were validated, and their accuracy was assessed. In another exploratory analysis, the presence of GGOs involving more than one lobe on pretreatment CT scans was identified as a risk factor for progression-free survival. Conclusions The assessment of GGO volume and distribution on pre-treatment CT scans could assist in monitoring and manage the risk of CIP in NSCLC patients receiving ICI therapy. Clinical relevance statement This study’s quantitative imaging and computational analysis can help identify NSCLC patients at high risk of CIP, allowing for better risk management and potentially improved outcomes in those receivingICI treatment. |
| first_indexed | 2024-03-07T14:56:08Z |
| format | Article |
| id | doaj.art-1f9d79e85c6548d99c903da4a63c15f9 |
| institution | Directory Open Access Journal |
| issn | 1471-2407 |
| language | English |
| last_indexed | 2024-03-07T14:56:08Z |
| publishDate | 2024-02-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Cancer |
| spelling | doaj.art-1f9d79e85c6548d99c903da4a63c15f92024-03-05T19:23:01ZengBMCBMC Cancer1471-24072024-02-0124111410.1186/s12885-024-12008-zQuantification of preexisting lung ground glass opacities on CT for predicting checkpoint inhibitor pneumonitis in advanced non-small cell lung cancer patientsXinyue Wang0Jinkun Zhao1Ting Mei2Wenting Liu3Xiuqiong Chen4Jingya Wang5Richeng Jiang6Zhaoxiang Ye7Dingzhi Huang8Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for CancerTianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for CancerTianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for CancerTianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for CancerTianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for CancerTianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for CancerTianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for CancerTianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for CancerTianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for CancerAbstract Background Immune checkpoint inhibitors (ICIs) can lead to life-threatening pneumonitis, and pre-existing interstitial lung abnormalities (ILAs) are a risk factor for checkpoint inhibitor pneumonitis (CIP). However, the subjective assessment of ILA and the lack of standardized methods restrict its clinical utility as a predictive factor. This study aims to identify non-small cell lung cancer (NSCLC) patients at high risk of CIP using quantitative imaging. Methods This cohort study involved 206 cases in the training set and 111 cases in the validation set. It included locally advanced or metastatic NSCLC patients who underwent ICI therapy. A deep learning algorithm labeled the interstitial lesions and computed their volume. Two predictive models were developed to predict the probability of grade ≥ 2 CIP or severe CIP (grade ≥ 3). Cox proportional hazard models were employed to analyze predictors of progression-free survival (PFS). Results In a training cohort of 206 patients, 21.4% experienced CIP. Two models were developed to predict the probability of CIP based on different predictors. Model 1 utilized age, histology, and preexisting ground glass opacity (GGO) percentage of the whole lung to predict grade ≥ 2 CIP, while Model 2 used histology and GGO percentage in the right lower lung to predict grade ≥ 3 CIP. These models were validated, and their accuracy was assessed. In another exploratory analysis, the presence of GGOs involving more than one lobe on pretreatment CT scans was identified as a risk factor for progression-free survival. Conclusions The assessment of GGO volume and distribution on pre-treatment CT scans could assist in monitoring and manage the risk of CIP in NSCLC patients receiving ICI therapy. Clinical relevance statement This study’s quantitative imaging and computational analysis can help identify NSCLC patients at high risk of CIP, allowing for better risk management and potentially improved outcomes in those receivingICI treatment.https://doi.org/10.1186/s12885-024-12008-zNon-small cell lung cancerImmune checkpoint inhibitorCheckpoint inhibitor pneumonitisGround glass opacityDeep learning |
| spellingShingle | Xinyue Wang Jinkun Zhao Ting Mei Wenting Liu Xiuqiong Chen Jingya Wang Richeng Jiang Zhaoxiang Ye Dingzhi Huang Quantification of preexisting lung ground glass opacities on CT for predicting checkpoint inhibitor pneumonitis in advanced non-small cell lung cancer patients BMC Cancer Non-small cell lung cancer Immune checkpoint inhibitor Checkpoint inhibitor pneumonitis Ground glass opacity Deep learning |
| title | Quantification of preexisting lung ground glass opacities on CT for predicting checkpoint inhibitor pneumonitis in advanced non-small cell lung cancer patients |
| title_full | Quantification of preexisting lung ground glass opacities on CT for predicting checkpoint inhibitor pneumonitis in advanced non-small cell lung cancer patients |
| title_fullStr | Quantification of preexisting lung ground glass opacities on CT for predicting checkpoint inhibitor pneumonitis in advanced non-small cell lung cancer patients |
| title_full_unstemmed | Quantification of preexisting lung ground glass opacities on CT for predicting checkpoint inhibitor pneumonitis in advanced non-small cell lung cancer patients |
| title_short | Quantification of preexisting lung ground glass opacities on CT for predicting checkpoint inhibitor pneumonitis in advanced non-small cell lung cancer patients |
| title_sort | quantification of preexisting lung ground glass opacities on ct for predicting checkpoint inhibitor pneumonitis in advanced non small cell lung cancer patients |
| topic | Non-small cell lung cancer Immune checkpoint inhibitor Checkpoint inhibitor pneumonitis Ground glass opacity Deep learning |
| url | https://doi.org/10.1186/s12885-024-12008-z |
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