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.
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.
Oral Oncol. 2024 Oct;157:106987. doi: 10.1016/j.oraloncology.2024.106987. Epub 2024 Aug 10.
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).
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.
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.
Our delta MRI-based radiomics model could be useful for predicting PFS and may guide subsequent treatment decisions after IC in LA-NPC.
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）。
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。
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。
我们基于 delta MRI 的放射组学模型可用于预测 PFS，并可能为 IC 后 LA-NPC 的后续治疗决策提供指导。
