基于德尔塔磁共振成像放射组学特征的列线图预测局部晚期鼻咽癌诱导化疗后的长期疗效。

Delta magnetic resonance imaging radiomics features‑based nomogram predicts long‑term efficacy after induction chemotherapy in locoregionally advanced nasopharyngeal carcinoma.

机构信息

Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China; Shanghai Clinical Research Center for Radiation Oncology, China; Shanghai Key Laboratory of Radiation Oncology, Shanghai 200032, China.

出版信息

Oral Oncol. 2024 Oct;157:106987. doi: 10.1016/j.oraloncology.2024.106987. Epub 2024 Aug 10.

DOI:10.1016/j.oraloncology.2024.106987

PMID:39133972

Abstract

PURPOSE

To establish and validate a delta-radiomics-based model for predicting progression-free survival (PFS) in patients with locoregionally advanced nasopharyngeal carcinoma (LA-NPC) following induction chemotherapy (IC).

METHODS AND MATERIALS

A total of 250 LA-NPC patients (training cohort: n = 145; validation cohort: n = 105) were enrolled. Radiomic features were extracted from MRI scans taken before and after IC, and changes in these features were calculated. Following feature selection, a delta-radiomics signature was constructed using LASSO-Cox regression analysis. A prognostic nomogram incorporating independent clinical indicators and the delta-radiomics signature was developed and assessed for calibration and discrimination. Risk stratification by the nomogram was evaluated using Kaplan-Meier methods.

RESULTS

The delta-radiomics signature, consisting of 12 features, was independently associated with prognosis. The nomogram, integrating the delta-radiomics signature and clinical factors demonstrated excellent calibration and discrimination. The model achieved a Harrell's concordance index (C-index) of 0.848 in the training cohort and 0.820 in the validation cohort. Risk stratification identified two groups with significantly different PFS rates. The three-year PFS for high-risk patients who received concurrent chemoradiotherapy (CCRT) or radiotherapy plus adjuvant chemotherapy (RT+AC) after IC was significantly higher than for those who received RT alone, reaching statistical significance. In contrast, for low-risk patients, the three-year PFS after IC was slightly higher for those who received CCRT or RT+AC compared to those who received RT alone; however, this difference did not reach statistical significance.

CONCLUSIONS

Our delta MRI-based radiomics model could be useful for predicting PFS and may guide subsequent treatment decisions after IC in LA-NPC.

摘要

目的

建立并验证一种基于 delta 放射组学的模型，用于预测接受诱导化疗（IC）后局部晚期鼻咽癌（LA-NPC）患者的无进展生存期（PFS）。

方法和材料

共纳入 250 例 LA-NPC 患者（训练队列：n=145；验证队列：n=105）。从 IC 前后的 MRI 扫描中提取放射组学特征，并计算这些特征的变化。经过特征选择，使用 LASSO-Cox 回归分析构建了 delta 放射组学特征。构建了包含独立临床指标和 delta 放射组学特征的预后列线图，并对其进行校准和区分评估。通过 Kaplan-Meier 方法评估列线图的风险分层。

结果

包含 12 个特征的 delta 放射组学特征与预后独立相关。整合 delta 放射组学特征和临床因素的列线图具有良好的校准和区分能力。该模型在训练队列中的 Harrell 一致性指数（C-index）为 0.848，在验证队列中的 C-index 为 0.820。风险分层确定了两组患者的 PFS 率有显著差异。接受 IC 后同步放化疗（CCRT）或放疗加辅助化疗（RT+AC）的高危患者的 3 年 PFS 明显高于单独接受 RT 的患者，达到统计学意义。相比之下，对于低危患者，接受 CCRT 或 RT+AC 的患者的 3 年 PFS 略高于单独接受 RT 的患者，但这种差异无统计学意义。