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Published on: May 20, 2016
Short-term quantitative CT changes in synchronous ground-glass nodules during immune checkpoint inhibitor therapy in
Yuting Zheng1,2,3, Shiqi Li1,2,3, Tingting Guo1,2,3
1Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Background:
Immune checkpoint inhibitors (ICIs) have improved survival in patients with lung cancer, leading to more frequent detection of synchronous ground-glass nodules (GGNs) during follow-up. This study aimed to evaluate short-term longitudinal quantitative CT changes of synchronous GGNs in lung cancer patients receiving ICI therapy.
Methods:
In this retrospective matched cohort study, we included 90 patients with lung cancers harboring 110 synchronous GGNs receiving 3-4 cycles of ICIs, and compared them with a matched cohort of incidentally detected pulmonary GGNs without any therapy. Baseline and follow-up chest CT scans were quantitatively analyzed to capture changes of diameter, volume, surface area, mass, mean CT attenuation, standard deviation of CT attenuation, solid component proportion, sphericity, energy and entropy. Volume change proportion (VCP) was assessed to define nodule response, using ± 25% as the threshold. Subgroup analyses were conducted according to nodule density and Lung-RADS category.
Results:
VCP showed that nodules in ICI group were more likely to show regression than those in the control group (23.6% vs. 1.8%, p< 0.001). Improvement in Lung-RADS category was also more common in the ICI group than in controls (8.2% vs 1.8%; p = 0.018). Compared with matched controls, nodules in the ICI group showed significantly lower monthly increases in diameter, volume, surface area and mass. Within the ICI group, nodules showed a significant reduction in diameter, while increases in mean CT value, standard deviation, solid component proportion, and entropy. In subgroup analyses, part-solid nodules (PSNs) showed larger volume reduction than pure GGNs, and nodules with Lung-RADS ≥ 4A showed a significant decrease in entropy.
Conclusion:
Among lung cancer patients receiving ICIs, synchronous GGNs exhibited attenuated longitudinal CT growth patterns, with favorable shifts in VCP and Lung-RADS categories, particularly in PSNs and nodules with Lung-RADS ≥ 4A.
