Baseline clinical and imaging predictors of treatment response and overall survival of patients with metastatic melanoma undergoing immunotherapy

Abstract Purpose We aimed to identify predictive clinical and CT imaging biomarkers and assess their predictive capacity regarding overall survival (OS) and treatment response in patients with metastatic melanoma undergoing immunotherapy. Methods The local institutional ethics committee approved this retrospective study and waived informed patient consent. 103 patients with immunotherapy for metastatic melanoma were randomly divided into training (n = 69) and validation cohort (n = 34). Baseline tumor markers (LDH, S100B), baseline CT imaging biomarkers (tumor burden, Choi density) and CT texture parameters (Entropy, Kurtosis, Skewness, uniformity, MPP, UPP) of the largest target lesion were extracted. To identify treatment response predictors, binary logistic regression analysis was performed in the training cohort and tested in the validation cohort. For OS, Cox regression and Kaplan Maier analyses were performed in the training cohort. Bivariate and multivariate models were established. Goodness of fit was assessed with Harrell’s C-index. Potential predictors were tested in the validation cohort also using Cox-regression and Kaplan-Meier analyses. Results Baseline S100B (Hazard ratio(HR) = 2.543, p0.018), tumor burden (HR = 1.657, p = 0.002) and Kurtosis (HR = 2.484, p  Conclusion We identified easily obtainable baseline clinical (S100B) and CT predictors (tumor burden and Kurtosis) of OS in patients with metastatic melanoma undergoing immunotherapy. However, imaging predictors did not predict treatment response.