{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:44:31Z","timestamp":1785545071748,"version":"3.56.0"},"reference-count":30,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMIR Cancer"],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n Immune checkpoint inhibitors represent an effective therapeutic approach for advanced gastric cancer. Their efficacy largely depends on the status of tumor biomarkers including human epidermal growth factor receptor 2 (HER2), programmed death-ligand 1 (PD-L1; combined positive score \u22651), and microsatellite instability-high (MSI-H). To noninvasively evaluate these biomarkers, researchers have developed radiomic models for individual biomarker prediction. However, in clinical practice, holistic prediction of these biomarkers as an integrated system is more efficient. Currently, the feasibility of implementing radiomics-based comprehensive biomarker prediction remains unclear, requiring further investigation.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n This study aimed to develop a radiomics-based predictive model using multiphase computed tomography (CT) images to holistically evaluate HER2, PD-L1, and MSI-H status in patients with gastric cancer.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n A retrospective analysis was conducted on 461 patients with gastric cancer who underwent radical gastrectomy between 2019 and 2022. Clinical data, contrast-enhanced CT images (arterial phase [AP] and portal venous phase [PP]), and pathological results were collected. Patients were categorized into two groups: (1) the programmed cell death protein-1 inhibitor panel-positive group, comprising patients with HER2 overexpression, PD-L1 positive, or MSI-H status; and (2) the negative group, comprising patients without HER2 amplification, PD-L1 negative, or microsatellite instability-low or microsatellite stable condition. Radiomic features (including first-order statistics, shape features, and wavelet-derived textures) were extracted from both AP and PP images, yielding 1834 features per phase. Least absolute shrinkage and selection operator regression was applied to select key features. In total, 3 models were constructed using the Extreme Gradient Boosting algorithm: AP-only (8 features), PP-only (22 features), and a fused model combining AP and PP features (20 features: 6 AP and 14 PP features). Model performance was evaluated using area under the curve (AUC), sensitivity, specificity, and decision curve analysis.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Of the 461 patients, 147 patients (31.9%) were classified into the panel-positive group. The clinical features were similar between the 2 groups. The fused model demonstrated superior performance in the test set (AUC 0.82, 95% CI 0.68\u20100.95), significantly outperforming AP-only (AUC 0.61, 95% CI 0.47\u20100.74) and PP-only models (AUC 0.70, 95% CI 0.49\u20100.91). Sensitivity and specificity for the AP-only, PP-only, and the fused model were 0.33 and 0.85; 0.50 and 0.86; and 0.60 and 0.83, respectively. Decision curve analysis confirmed that the fused model provided higher clinical net benefit across threshold probabilities.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n The construction of integrated biomarker prediction models through radiomics demonstrates technical feasibility, offering a promising methodology for comprehensive tumor characterization.<\/jats:p>\n <\/jats:sec>","DOI":"10.2196\/67379","type":"journal-article","created":{"date-parts":[[2025,5,8]],"date-time":"2025-05-08T12:05:14Z","timestamp":1746705914000},"page":"e67379-e67379","source":"Crossref","is-referenced-by-count":0,"title":["Prediction of a Panel of Programmed Cell Death Protein-1 (PD-1) Inhibitor\u2013Sensitive Biomarkers Using Multiphase Computed Tomography Imaging Textural Features: Retrospective Cohort Analysis"],"prefix":"10.2196","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2381-044X","authenticated-orcid":false,"given":"Shiqi","family":"Wang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-5691-5912","authenticated-orcid":false,"given":"Na","family":"Chai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9767-0742","authenticated-orcid":false,"given":"Jingji","family":"Xu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3825-8798","authenticated-orcid":false,"given":"Pengfei","family":"Yu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3296-4181","authenticated-orcid":false,"given":"Luguang","family":"Huang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2821-5017","authenticated-orcid":false,"given":"Quan","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6311-1811","authenticated-orcid":false,"given":"Zhifeng","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6180-7412","authenticated-orcid":false,"given":"Bin","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6619-8695","authenticated-orcid":false,"given":"Jiangpeng","family":"Wei","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8869-5596","authenticated-orcid":false,"given":"Xiangjie","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9722-872X","authenticated-orcid":false,"given":"Gang","family":"Ji","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0862-3208","authenticated-orcid":false,"given":"Minwen","family":"Zheng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2025,7,11]]},"reference":[{"issue":"3","key":"R1","doi-asserted-by":"publisher","first-page":"209","DOI":"10.3322\/caac.21660","article-title":"Global Cancer Statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries","volume":"71","author":"Sung","journal-title":"CA Cancer J Clin"},{"issue":"1","key":"R2","doi-asserted-by":"publisher","DOI":"10.1186\/s12957-016-1042-y","article-title":"The patterns and timing of recurrence after curative resection for gastric cancer in China","volume":"14","author":"Liu","journal-title":"World J Surg Oncol"},{"issue":"7","key":"R3","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2017.1087","article-title":"Association of adjuvant chemotherapy with survival in patients with stage II or III gastric cancer","volume":"152","author":"Jiang","journal-title":"JAMA Surg"},{"issue":"10294","key":"R4","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1016\/S0140-6736(21)00797-2","article-title":"First-line nivolumab plus chemotherapy versus chemotherapy alone for advanced gastric, gastro-oesophageal junction, and oesophageal adenocarcinoma (CheckMate 649): a randomised, open-label, phase 3 trial","volume":"398","author":"Janjigian","journal-title":"Lancet"},{"issue":"11","key":"R5","doi-asserted-by":"publisher","DOI":"10.1016\/j.esmoop.2024.103967","article-title":"PD-L1 thresholds predict efficacy of immune checkpoint inhibition in first-line treatment of advanced gastroesophageal adenocarcinoma. A systematic review and meta-analysis of seven phase III randomized trials","volume":"9","author":"Formica","journal-title":"ESMO Open"},{"issue":"10418","key":"R6","doi-asserted-by":"publisher","first-page":"2197","DOI":"10.1016\/S0140-6736(23)02033-0","article-title":"Pembrolizumab plus trastuzumab and chemotherapy for HER2-positive gastric or gastro-oesophageal junction adenocarcinoma: interim analyses from the phase 3 KEYNOTE-811 randomised placebo-controlled trial","volume":"402","author":"Janjigian","journal-title":"Lancet"},{"issue":"7890","key":"R7","doi-asserted-by":"publisher","first-page":"727","DOI":"10.1038\/s41586-021-04161-3","article-title":"The KEYNOTE-811 trial of dual PD-1 and HER2 blockade in HER2-positive gastric cancer","volume":"600","author":"Janjigian","journal-title":"Nature New Biol"},{"issue":"1","key":"R8","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-024-76296-y","article-title":"Efficacy and safety of dual blockade of HER2 and PD-1 in patients with HER2-positive gastric cancer: a retrospective, multicentre study","volume":"14","author":"Cen","journal-title":"Sci Rep"},{"issue":"5","key":"R9","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoncol.2018.0013","article-title":"Safety and efficacy of pembrolizumab monotherapy in patients with previously treated advanced gastric and gastroesophageal junction cancer: phase 2 clinical KEYNOTE-059 trial","volume":"4","author":"Fuchs","journal-title":"JAMA Oncol"},{"issue":"1","key":"R10","doi-asserted-by":"publisher","DOI":"10.1016\/j.esmoop.2020.100036","article-title":"Predictive role of microsatellite instability for PD-1 blockade in patients with advanced gastric cancer: a meta-analysis of randomized clinical trials","volume":"6","author":"Pietrantonio","journal-title":"ESMO Open"},{"key":"R11","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2021.646355","article-title":"Appropriate PD-L1 cutoff value for gastric cancer immunotherapy: a systematic review and meta-analysis","volume":"11","author":"Xie","journal-title":"Front Oncol"},{"issue":"3","key":"R12","doi-asserted-by":"publisher","first-page":"278","DOI":"10.1038\/s41416-019-0515-5","article-title":"Can PD-L1 expression evaluated by biopsy sample accurately reflect its expression in the whole tumour in gastric cancer?","volume":"121","author":"Yamashita","journal-title":"Br J Cancer"},{"issue":"8","key":"R13","doi-asserted-by":"publisher","first-page":"4413","DOI":"10.1245\/s10434-020-09405-6","article-title":"Effect of additional trastuzumab in neoadjuvant and adjuvant treatment for patients with resectable HER2-positive gastric cancer","volume":"28","author":"He","journal-title":"Ann Surg Oncol"},{"issue":"12","key":"R14","doi-asserted-by":"publisher","first-page":"749","DOI":"10.1038\/nrclinonc.2017.141","article-title":"Radiomics: the bridge between medical imaging and personalized medicine","volume":"14","author":"Lambin","journal-title":"Nat Rev Clin Oncol"},{"issue":"2","key":"R15","doi-asserted-by":"publisher","first-page":"563","DOI":"10.1148\/radiol.2015151169","article-title":"Radiomics: images are more than pictures, they are data","volume":"278","author":"Gillies","journal-title":"Radiology"},{"issue":"7","key":"R16","doi-asserted-by":"publisher","first-page":"1317","DOI":"10.1016\/j.acra.2022.10.012","article-title":"Quantitative radiological features and deep learning for the non-invasive evaluation of programmed death ligand 1 expression levels in gastric cancer patients: a digital biopsy study","volume":"30","author":"Xie","journal-title":"Acad Radiol"},{"issue":"1","key":"R17","doi-asserted-by":"publisher","first-page":"220","DOI":"10.1007\/s00261-022-03709-9","article-title":"Can PD-L1 expression be predicted by contrast-enhanced CT in patients with gastric adenocarcinoma? A preliminary retrospective study","volume":"48","author":"Gu","journal-title":"Abdom Radiol (NY)"},{"key":"R18","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2022.905203","article-title":"Evaluation of epidermal growth factor receptor 2 status in gastric cancer by CT-based deep learning radiomics nomogram","volume":"12","author":"Guan","journal-title":"Front Oncol"},{"issue":"3","key":"R19","doi-asserted-by":"publisher","first-page":"e86","DOI":"10.1016\/j.acra.2020.02.018","article-title":"CT radiomics for distinction of human epidermal growth factor receptor 2 negative gastric cancer","volume":"28","author":"Wang","journal-title":"Acad Radiol"},{"key":"R20","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejrad.2023.110719","article-title":"Development and external validation of a non-invasive imaging biomarker to estimate the microsatellite instability status of gastric cancer and its prognostic value: the combination of clinical and quantitative CT-imaging features","volume":"162","author":"Zhao","journal-title":"Eur J Radiol"},{"issue":"6","key":"R21","doi-asserted-by":"publisher","first-page":"2036","DOI":"10.1007\/s00261-022-03507-3","article-title":"A multicenter study on the preoperative prediction of gastric cancer microsatellite instability status based on computed tomography radiomics","volume":"47","author":"Liang","journal-title":"Abdom Radiol"},{"key":"R22","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2022.883109","article-title":"CT-based radiomic nomogram for preoperative prediction of DNA mismatch repair deficiency in gastric cancer","volume":"12","author":"Zeng","journal-title":"Front Oncol"},{"key":"R23","doi-asserted-by":"publisher","DOI":"10.1093\/annonc\/12.suppl_1.s15","article-title":"HER2 overexpression in various tumor types, focussing on its relationship to the development of invasive breast cancer","volume":"12 Suppl 1","author":"M\u00e9nard","journal-title":"Ann Oncol"},{"issue":"2","key":"R24","doi-asserted-by":"publisher","first-page":"322","DOI":"10.1007\/s00330-015-3845-6","article-title":"Magnetic resonance imaging texture analysis classification of primary breast cancer","volume":"26","author":"Waugh","journal-title":"Eur Radiol"},{"issue":"1","key":"R25","doi-asserted-by":"publisher","first-page":"28","DOI":"10.4132\/KoreanJPathol.2013.47.1.28","article-title":"Microsatellite instability status in gastric cancer: a reappraisal of its clinical significance and relationship with mucin phenotypes","volume":"47","author":"Kim","journal-title":"Korean J Pathol"},{"issue":"8","key":"R26","doi-asserted-by":"publisher","first-page":"5362","DOI":"10.1007\/s00330-022-08651-4","article-title":"A computed tomography-based radiomics signature for predicting expression of programmed death ligand 1 in head and neck squamous cell carcinoma","volume":"32","author":"Zheng","journal-title":"Eur Radiol"},{"issue":"2","key":"R27","doi-asserted-by":"publisher","first-page":"342","DOI":"10.1016\/j.ejrad.2012.10.023","article-title":"Assessment of tumor heterogeneity by CT texture analysis: can the largest cross-sectional area be used as an alternative to whole tumor analysis?","volume":"82","author":"Ng","journal-title":"Eur J Radiol"},{"issue":"7","key":"R28","doi-asserted-by":"publisher","first-page":"797","DOI":"10.1111\/j.1365-2559.2008.03028.x","article-title":"Assessment of a HER2 scoring system for gastric cancer: results from a validation study","volume":"52","author":"Hofmann","journal-title":"Histopathology"},{"issue":"8","key":"R29","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0161278","article-title":"Tumor heterogeneity in human epidermal growth factor receptor 2 (HER2)-positive advanced gastric cancer assessed by CT texture analysis: association with survival after trastuzumab treatment","volume":"11","author":"Yoon","journal-title":"PLoS ONE"},{"issue":"1","key":"R30","doi-asserted-by":"publisher","first-page":"126","DOI":"10.1097\/PAS.0b013e31817ec2b1","article-title":"Pathologic predictors of microsatellite instability in colorectal cancer","volume":"33","author":"Greenson","journal-title":"Am J Surg Pathol"}],"container-title":["JMIR Cancer"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/cancer.jmir.org\/2025\/1\/e67379","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T22:28:00Z","timestamp":1785536880000},"score":1,"resource":{"primary":{"URL":"https:\/\/cancer.jmir.org\/2025\/1\/e67379"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,11]]},"references-count":30,"URL":"https:\/\/doi.org\/10.2196\/67379","relation":{},"ISSN":["2369-1999"],"issn-type":[{"value":"2369-1999","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,11]]},"article-number":"v11i3e67379"}}