AUTHOR=Yang Xu , Liu Jun , Lu Xia , Kan Ying , Wang Wei , Zhang Shuxin , Liu Lei , Zhang Hui , Li Jixia , Yang Jigang 

TITLE=Development and Validation of a Nomogram Based on 18F-FDG PET/CT Radiomics to Predict the Overall Survival in Adult Hemophagocytic Lymphohistiocytosis

JOURNAL=Frontiers in Medicine

VOLUME=8

YEAR=2021

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2021.792677

DOI=10.3389/fmed.2021.792677

ISSN=2296-858X

ABSTRACT=<p><bold>Purpose:</bold> Hemophagocytic lymphohistiocytosis (HLH) is a rare and severe disease with a poor prognosis. We aimed to determine if <sup>18</sup>F-fluorodeoxyglucose (<sup>18</sup>F-FDG) PET/CT-derived radiomic features alone or combination with clinical parameters could predict survival in adult HLH.</p><p><bold>Methods:</bold> This study included 70 adults with HLH (training cohort, <italic>n</italic> = 50; validation cohort, <italic>n</italic> = 20) who underwent pretherapeutic <sup>18</sup>F-FDG PET/CT scans between August 2016 and June 2020. Radiomic features were extracted from the liver and spleen on CT and PET images. For evaluation of 6-month survival, the features exhibiting <italic>p</italic> &lt; 0.1 in the univariate analysis between non-survivors and survivors were selected. The least absolute shrinkage and selection operator (LASSO) regression analysis was used to develop a radiomics score (Rad-score). A nomogram was built by the multivariate regression analysis to visualize the predictive model for 3-month, 6-month, and 1-year survival, while the performance and usefulness of the model were evaluated by calibration curves, the receiver operating characteristic (ROC) curves, and decision curves.</p><p><bold>Results:</bold> The Rad-score was able to predict 6-month survival in adult HLH, with area under the ROC curves (AUCs) of 0.927 (95% CI: 0.878–0.974) and 0.869 (95% CI: 0.697–1.000) in the training and validation cohorts, respectively. The radiomics nomogram combining the Rad-score with the clinical parameters resulted in better performance for predicting 6-month survival than the clinical model or the Rad-score alone. Moreover, the nomogram displayed superior discrimination, calibration, and clinical usefulness in both the cohorts.</p><p><bold>Conclusion:</bold> The newly developed Rad-score is a powerful predictor for overall survival (OS) in adults with HLH. The nomogram has great potential for predicting 3-month, 6-month, and 1-year survival, which may timely guide personalized treatments for adult HLH.</p>