Identification of D842V mutation in gastrointestinal stromal tumors based on CT radiomics: a multi-center study.

Background: Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract. Recent advent of tyrosine kinase inhibitors (TKIs) has significantly improved the prognosis of GIST patients. However, responses to TKI therapy can vary depending on the specific gene mutation. D842V, which is the most common mutation in platelet-derived growth factor receptor alpha exon 18, shows no response to imatinib and sunitinib. Radiomics features based on venous-phase contrast-enhanced computed tomography (CECT) have shown potential in non-invasive prediction of GIST genotypes. This study sought to determine whether radiomics features could help distinguish GISTs with D842V mutations.
Methods: A total of 872 pathologically confirmed GIST patients with CECT data available from three independent centers were included and divided into the training cohort ( n = 487 ) and the external validation cohort ( n = 385 ). Clinical features including age, sex, tumor size and location were collected. Radiomics features on the largest axial image of venous-phase CECT were analyzed and a total of two radiomics features were selected after feature selection. Random forest models trained on non-radiomics features only (the non-radiomics model) and on both non-radiomics and radiomics features (the combined model) were compared.
Results: The combined model showed better average precision (0.250 vs. 0.102, p = 0.039) and F1 score (0.253 vs. 0.155, p = 0.012) than the non-radiomics model. There was no significant difference in ROC-AUC (0.728 vs. 0.737, p = 0.836) and geometric mean (0.737 vs. 0.681, p = 0.352).
Conclusions: This study demonstrated the potential of radiomics features based on venous-phase CECT images to identify D842V mutation in GISTs. Our model may provide an alternative approach to guide TKI therapy for patients inaccessible to sequence variant testing, potentially improving treatment outcomes for GIST patients especially in resource-limited settings.
Competing Interests: Declarations. Ethics approval and consent to participate: The institutional review board approved the study protocol, and the study was conducted in accordance with ethical principles of the 1975 Declaration of Helsinki and subsequent revisions (KY2023-002-B). Consent requirement have been waived by institutional review board due to its retrospective study. Consent for publication: Not applicable. Competing interests: The Author (Yang Song) from a commercial company, Siemens Healthineers Ltd., was a MR collaboration scientist doing technical support in this study under Siemens collaboration regulation without any payment and personal concern regarding to this study. The authors of this manuscript declare no other relationships with any companies, whose products or services may be related to the subject matter of the article.
(© 2024. The Author(s).)