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Background  To assess CT texture based quantitative imaging biomarkers in the prediction of progression free survival (PFS) and overall survival (OS) in patients with clear cell renal cell carcinoma undergoing treatment with Sunitinib.    Methods  In this retrospective study, measurable lesions of 40 patients were selected based on RECIST criteria on standard contrast enhanced CT before and 2 months after treatment with Sunitinib. CT Texture analysis was performed using TexRAD research software (TexRAD Ltd, Cambridge, UK). Using a Cox regression model, correlation of texture parameters with measured time to progression and overall survival were assessed. Evaluation of combined International Metastatic Renal-Cell Carcinoma Database Consortium Model (IMDC) score with texture parameters was also performed.    Results  Size normalized standard deviation (nSD) alone at baseline and follow-up after treatment was a predictor of OS (Hazard ratio (HR) = 0.01 and 0.02; 95% confidence intervals (CI): 0.00 – 0.29 and 0.00 – 0.39;  p  = 0.01 and 0.01). Entropy following treatment and entropy change before and after treatment were both significant predictors of OS (HR = 2.68 and 87.77; 95% CI = 1.14 – 6.29 and 1.26 – 6115.69;  p  = 0.02 and  p  = 0.04). nSD was also a predictor of PFS at baseline and follow-up (HR = 0.01 and 0.01: 95% CI: 0.00 – 0.31 and 0.001 – 0.22;  p  = 0.01 and  p  = 0.003). When nSD at baseline or at follow-up was combined with IMDC, it improved the association with OS and PFS compared to IMDC alone.    Conclusion  Size normalized standard deviation from CT at baseline and follow-up scans is correlated with OS and PFS in clear cell renal cell carcinoma treated with Sunitinib.

CT texture analysis: a potential tool for prediction of survival in patients with metastatic clear cell carcinoma treated with sunitinib