基于列线图的优化Radscore用于新辅助化疗后宫颈癌患者淋巴结转移的术前预测
A nomogram-based optimized Radscore for preoperative prediction of lymph node metastasis in patients with cervical cancer after neoadjuvant chemotherapy.
作者信息
Ai Conghui, Zhang Lan, Ding Wei, Zhong Suixing, Li Zhenhui, Li Miaomiao, Zhang Huimei, Zhang Lan, Zhang Lei, Hu Hongyan
机构信息
Department of Radiology, The Third Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China.
Department of Radiation Oncology, The Third Affiliated Hospital of Kunming Medical University (Yunnan Cancer Hospital, Yunnan Cancer Center), Kunming, China.
出版信息
Front Oncol. 2023 Aug 15;13:1117339. doi: 10.3389/fonc.2023.1117339. eCollection 2023.
PURPOSE
To construct a superior single-sequence radiomics signature to assess lymphatic metastasis in patients with cervical cancer after neoadjuvant chemotherapy (NACT).
METHODS
The first half of the study was retrospectively conducted in our hospital between October 2012 and December 2021. Based on the history of NACT before surgery, all pathologies were divided into the NACT and surgery groups. The incidence rate of lymphatic metastasis in the two groups was determined based on the results of pathological examination following lymphadenectomy. Patients from the primary and secondary centers who received NACT were enrolled for radiomics analysis in the second half of the study. The patient cohorts from the primary center were randomly divided into training and test cohorts at a ratio of 7:3. All patients underwent magnetic resonance imaging after NACT. Segmentation was performed on T1-weighted imaging (T1WI), T2-weighted imaging, contrast-enhanced T1WI (CET1WI), and diffusion-weighted imaging.
RESULTS
The rate of lymphatic metastasis in the NACT group (33.2%) was significantly lower than that in the surgery group (58.7%, P=0.007). The area under the receiver operating characteristic curve values of Radscore_CET1WI for predicting lymph node metastasis and non-lymphatic metastasis were 0.800 and 0.797 in the training and test cohorts, respectively, exhibiting superior diagnostic performance. After combining the clinical variables, the tumor diameter on magnetic resonance imaging was incorporated into the Rad_clin model constructed using Radscore_CET1WI. The Hosmer-Lemeshow test of the Rad_clin model revealed no significant differences in the goodness of fit in the training (P=0.594) or test cohort (P=0.748).
CONCLUSIONS
The Radscore provided by CET1WI may achieve a higher diagnostic performance in predicting lymph node metastasis. Superior performance was observed with the Rad_clin model.
目的
构建一种更优的单序列影像组学特征，以评估新辅助化疗（NACT）后宫颈癌患者的淋巴结转移情况。
方法
研究的前半部分于2012年10月至2021年12月在我院进行回顾性研究。根据术前NACT病史，将所有病理结果分为NACT组和手术组。根据淋巴结清扫术后的病理检查结果确定两组淋巴结转移的发生率。研究后半部分纳入来自一级和二级中心接受NACT的患者进行影像组学分析。将来自一级中心的患者队列以7:3的比例随机分为训练组和测试组。所有患者在NACT后均接受磁共振成像检查。对T1加权成像（T1WI）、T2加权成像、对比增强T1WI（CET1WI）和扩散加权成像进行分割。
结果
NACT组的淋巴结转移率（33.2%）显著低于手术组（58.7%，P = 0.007）。在训练组和测试组中，用于预测淋巴结转移和非淋巴结转移的Radscore_CET1WI的受试者操作特征曲线下面积值分别为0.800和0.797，显示出卓越的诊断性能。在合并临床变量后，将磁共振成像上的肿瘤直径纳入使用Radscore_CET1WI构建的Rad_clin模型中。Rad_clin模型的Hosmer-Lemeshow检验显示，训练组（P = 0.594）或测试组（P = 0.748）的拟合优度无显著差异。
结论
CET1WI提供的Radscore在预测淋巴结转移方面可能具有更高的诊断性能。Rad_clin模型表现出卓越的性能。
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