基于计算机断层扫描的食管鳞状细胞癌肿瘤及淋巴结区域影像组学的预后价值和增量价值
Prognostic and incremental value of computed tomography-based radiomics from tumor and nodal regions in esophageal squamous cell carcinoma.
作者信息
Cao Bangrong, Mi Kun, Dai Wei, Liu Tong, Xie Tianpeng, Li Qiang, Lang Jinyi, Han Yongtao, Peng Lin, Wang Qifeng
机构信息
Radiation Oncology Key Laboratory of Sichuan Province.
Department of Biobank.
出版信息
Chin J Cancer Res. 2022 Apr 30;34(2):71-82. doi: 10.21147/j.issn.1000-9604.2022.02.02.
OBJECTIVE
This study aimed to evaluate the prognostic value of preoperative radiomics and establish an integrated model for esophageal squamous cell cancer (ESCC).
METHODS
A total of 931 patients were retrospectively enrolled in this study (training cohort, n=624; validation cohort, n=307). Radiomics features were obtained by contrast-enhanced computed tomography (CT) before esophagectomy. A radiomics index was set based on features of tumor and reginal lymph nodes by using the least absolute shrinkage and selection operator (LASSO) Cox regression. Prognostic nomogram was built based on radiomics index and other independent risk factors. The prognostic value was assessed by using Harrell's concordance index, time-dependent receiver operating characteristics and Kaplan-Meier curves.
RESULTS
Twelve radiomic features from tumor and lymph node regions were identified to build a radiomics index, which was significantly associated with overall survival (OS) in both training cohort and validation cohort. The radiomics index was highly correlated with clinical tumor-node-metastasis (cTNM) and pathologic TNM (pTNM) stages, but it demonstrated a better prognostic value compared with cTNM stage and was almost comparable with pTNM stage. Multivariable Cox regression showed that the radiomics index was an independent prognostic factor. An integrated model was constructed based on gender, preoperative serum sodium concentration, pTNM and the radiomics index for clinical usefulness. The integrated model demonstrated discriminatory ability better compared with the traditional clinical-pathologic model and pTNM alone, indicating incremental value for prognosis.
CONCLUSIONS
CT-based radiomics for primary tumor and reginal lymph nodes was sufficient in predicting OS for patients with ESCC. The integrated model demonstrated incremental value for prognosis and was robust for clinical applications.
目的
本研究旨在评估术前放射组学的预后价值，并建立食管鳞状细胞癌（ESCC）的综合模型。
方法
本研究回顾性纳入了931例患者（训练队列，n = 624；验证队列，n = 307）。在食管切除术前通过对比增强计算机断层扫描（CT）获取放射组学特征。使用最小绝对收缩和选择算子（LASSO）Cox回归，基于肿瘤和区域淋巴结的特征设置放射组学指数。基于放射组学指数和其他独立危险因素构建预后列线图。使用Harrell一致性指数、时间依赖性受试者工作特征曲线和Kaplan-Meier曲线评估预后价值。
结果
从肿瘤和淋巴结区域识别出12个放射组学特征以构建放射组学指数，该指数在训练队列和验证队列中均与总生存期（OS）显著相关。放射组学指数与临床肿瘤-淋巴结-转移（cTNM）和病理TNM（pTNM）分期高度相关，但与cTNM分期相比，其显示出更好的预后价值，且与pTNM分期几乎相当。多变量Cox回归显示放射组学指数是一个独立的预后因素。基于性别、术前血清钠浓度、pTNM和放射组学指数构建了一个综合模型以用于临床。与传统临床病理模型和单独的pTNM相比，该综合模型显示出更好的辨别能力，表明其对预后具有增量价值。
结论
基于CT的原发性肿瘤和区域淋巴结放射组学足以预测ESCC患者的OS。该综合模型显示出对预后的增量价值，并且在临床应用中具有稳健性。
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