Jin Xin, Li Wen-Zhu, Guo Yi-Hao, Wu Gang, Huang Wei-Yuan, Chen Feng
Department of Radiology, Hainan Affiliated Hospital of Hainan Medical University (Hainan General Hospital), Haikou, China.
Department of Radiotherapy Hainan Affiliated Hospital of Hainan Medical University (Hainan General Hospital), Haikou, China.
Eur Radiol. 2025 Feb 14. doi: 10.1007/s00330-025-11433-3.
The purpose of this study was to explore the potential value of the radiomics model based on dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI), compared with the clinical model mostly based on the epidermal growth factor receptor (EGFR) expression, in predicting progression-free survival (PFS) in patients with locally advanced nasopharyngeal carcinoma (LA-NPC) treated with nimotuzumab (NTZ).
A total of 136 patients with LA-NPC who received NTZ treatment between January 2018 and June 2022 were included in this study. Patients were randomly divided into training (n = 95) and validation (n = 41) groups in a 7:3 ratio. DCE-MRI radiomics, clinical, and clinical-radiomics models were built to predict PFS. The relationship between EGFR expression levels and NTZ efficacy was assessed using Kaplan-Meier curves. Model performance was assessed using the area under the curve, calibration, and DeLong tests. Decision curve analysis evaluated net clinical benefit. Patients were stratified into high- and low-risk groups based on optimal model radiomic scores, and prognoses were compared using Kaplan-Meier curves.
Univariate Cox regression analysis demonstrated that EGFR expression level was the only independent predictive factor of PFS (p < 0.05). Patients with EGFR 3+ receiving NTZ therapy had significantly longer PFS than those with EGFR 1+ (hazard ratio = 3.025, p < 0.05). The clinical-radiomics model exhibited superior predictive efficacy, compared with the radiomics and clinical models (training set: 0.887 vs. 0.845, 0.654; validation set: 0.831, 0.824 vs. 0.567, all p < 0.001).
The clinical-radiomics models using DCE-MRI and EGFR levels can effectively predict NTZ efficacy in LA-NPC patients, providing objective evidence for personalized treatment adjustments.
Question How can the response to nimotuzumab treatment in patients with locally advanced nasopharyngeal carcinoma be accurately predicted using non-invasive imaging methods? Findings A combined clinical and radiomic model using dynamic contrast-enhanced magnetic resonance imaging showed improved predictive performance for progression-free survival in patients treated with nimotuzumab. Clinical relevance The study provides evidence for using a combined clinical and radiomic approach, offering a non-invasive method to predict treatment response and guide personalized treatment strategies for patients with locally advanced nasopharyngeal carcinoma, potentially improving patient outcomes.
本研究旨在探讨基于动态对比增强磁共振成像（DCE-MRI）的影像组学模型与主要基于表皮生长因子受体（EGFR）表达的临床模型相比，在预测接受尼妥珠单抗（NTZ）治疗的局部晚期鼻咽癌（LA-NPC）患者无进展生存期（PFS）方面的潜在价值。
本研究纳入了2018年1月至2022年6月期间接受NTZ治疗的136例LA-NPC患者。患者按7:3的比例随机分为训练组（n = 95）和验证组（n = 41）。构建DCE-MRI影像组学、临床和临床-影像组学模型来预测PFS。使用Kaplan-Meier曲线评估EGFR表达水平与NTZ疗效之间的关系。使用曲线下面积、校准和DeLong检验评估模型性能。决策曲线分析评估净临床获益。根据最佳模型影像组学评分将患者分为高风险和低风险组，并使用Kaplan-Meier曲线比较预后。
单因素Cox回归分析表明，EGFR表达水平是PFS的唯一独立预测因素（p < 0.05）。接受NTZ治疗的EGFR 3+患者的PFS显著长于EGFR 1+患者（风险比 = 3.025，p < 0.05）。与影像组学和临床模型相比，临床-影像组学模型表现出更好的预测效能（训练集：0.887对0.845、0.654；验证集：0.831、0.824对0.567，所有p < 0.001）。
使用DCE-MRI和EGFR水平的临床-影像组学模型可以有效预测LA-NPC患者的NTZ疗效，为个性化治疗调整提供客观依据。
问题如何使用非侵入性成像方法准确预测局部晚期鼻咽癌患者对尼妥珠单抗治疗的反应？发现使用动态对比增强磁共振成像的临床和影像组学联合模型对接受尼妥珠单抗治疗的患者的无进展生存期显示出更好的预测性能。临床意义该研究为使用临床和影像组学联合方法提供了证据，提供了一种非侵入性方法来预测治疗反应并指导局部晚期鼻咽癌患者的个性化治疗策略，可能改善患者预后。
