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摘要
Objective: To investigate the predictive value of computed tomography (CT) texture analysis for c-KIT Exon 11 gene mutation in gastrointestinal stromal tumors (GIST). Methods: The retrospective and descriptive study was conducted. The clinicopathological data of 285 GIST patients who were admitted to three domestic medical centers (93 cases in Huzhou Central Hospital, 92 cases in Fu Yang People's Hospital and 100 cases in Shanghai GuangHua Hospital of Integrated Traditional Chinese and Western Medicine) from January 2012 to May 2020 were collected. There were 130 males and 155 females, aged from 25 to 82 years, with a median age of 62 years. Of the 285 patients, 190 cases with mutated c-KIT Exon 11 gene and 95 with non-mutated c-KIT Exon 11 gene were allocated into mutation group and non-mutation group. All patients underwent preoperative CT examination. Observation indicators: (1) comparison of clinicopathological features between groups; (2) consistency check of CT texture parameters between observers; (3) comparison of CT texture parameters between groups; (4) diagnostic efficiency of clinicopathological parameters and CT texture parameters. The intraclass correlation coefficient (ICC) analysis was used for consistency check of CT texture parameters between observers, and ICC>0.80 was defined as good consistency between observers. The means of CT texture parameters with ICC>0.80 were used for further analysis. The Shapiro Wilk was used for normality test of measurement data. Measurement data with normal distribution were represented as Mean±SD, and comparison between groups was analyzed using the independent sample t test. Measurement data with skewed distribution were represented as M (P25, P75), and comparison between groups was analyzed using the Mann-Whitney U test. Count data were described as absolute numbers, and comparison between groups was analyzed using the chi-square test. Comparison of ordinal data was analyzed using the Kruskal-Wallis rank sum test. The multiunivariate Logistic regression was used to combine parameters with significant differences, and the receiver operating characteristic curve was used to evaluate the predictive value of parameters for c-KIT Exon 11 gene mutation in GIST. Data from January 2012 to January 2018 were used for internal test, and data from February 2018 to May 2020 were used for external validation. The Delong test was used to compare areas under curve. Results: (1) Comparison of clinico-pathological features between groups: cases negative, weakly positive, positive, strongly positive for CD34 expression and cases negative, weakly positive, positive, strongly positive for CD117 expression were 0, 15, 50, 125 and 5, 15, 55, 115 for the mutation group, the above indicators were 5, 55, 5, 30 and 5, 45, 15, 30 for the non-mutation group, respectively. There were significant differences in the above indicators between the two groups (Z=11.53, 12.32, P<0.05). (2) Consistency check of CT texture parameters between observers: in plain CT, the ICC of texture parameters median value, standard deviation, cluster prominence, mean value, skewness, kurtosis, uniformity, energy, entropy, Inertia, inverse difference moment and Haralick were 0.77, 0.79, 0.75, 0.83, 0.89, 0.85, 0.83, 0.81, 0.85, 0.87, 0.82, 0.84; in arterial phase, the above indicators were 0.79, 0.71, 0.74, 0.83, 0.81, 0.86, 0.87, 0.80, 0.84, 0.82, 0.83, 0.81; in venous phase, the above indicators were 0.74, 0.72, 0.70, 0.88, 0.81, 0.84, 0.89, 0.82, 0.83, 0.84, 0.86, 0.88. (3) Comparison of CT texture parameters between groups: skewness and inverse difference moment in plain CT, mean value and energy in arterial phase, skewness, uniformity, energy, inverse difference moment and Haralick in venous phase of the mutation group were 0.78±0.38, 4.22(3.18, 5.38), 5.51±1.87, 0.013(0.007, 0.020), 0.66±0.20, 4.40±1.41, 0.004(0.001, 0.007), 0.23(0.15, 0.28), 0.24±0.10, respectively, versus 0.59±0.25, 5.16(4.35, 6.10), 3.96±1.04, 0.020(0.014, 0.027), 0.45±0.12, 6.22±2.09, 0.005(0.003, 0.008), 0.25(0.21, 0.28), 0.18±0.06 of the non-mutation group. There were significant differences in the above indicators between the two groups (t=-2.17, Z=-6.87, t=-4.03, Z=-11.43, t=-2.21, -3.92, Z=-2.06, -4.18, t=-3.02, P<0.05). (4) Diagnostic efficiency of clinicopathological parameters and CT texture parameters: ROC analysis of internal test data showed that CD34 and CD117 had AUC of 0.75 and 0.71, combined clinicopathological parameters had AUC of 0.75, single CT texture parameters had AUC of 0.54-0.67, combined CT texture parameters had AUC of 0.79, clinicopathological parameters combined with CT texture parameters had AUC of 0.89. ROC analysis of external test data showed that CD34 and CD117 had AUC of 0.77 and 0.72, combined clinicopathological parameters had AUC of 0.78, single CT texture examination had AUC of 0.51-0.73, combined CT texture parameters had AUC of 0.80, clinicopathological parameters combined with CT texture parameters had AUC of 0.88. Delong test showed that the combination of clinicopathological parameters and CT texture parameters had a higher AUC than combination of clinicopathological parameters (Z=2.13, P<0.05). The combination of clinicopathological parameters and CT texture parameters had no significant difference in the AUC compared with the combination of CT texture parameters (Z=1.66, P>0.05). Conclusion: CT texture analysis can early and non-invasively predict the mutation status of c-KIT Exon 11 gene in GIST, the combination of clinicopathologic parameters and CT texture parameters has better predictive performance.
