MRI delta radiomics during chemoradiotherapy for prognostication in locally advanced cervical cancer.

IF 3.4 2区医学 Q2 ONCOLOGY BMC Cancer Pub Date : 2025-01-22 DOI:10.1186/s12885-025-13509-1

Kari S Wagner-Larsen, Njål Lura, Ankush Gulati, Stian Ryste, Erlend Hodneland, Kristine E Fasmer, Kathrine Woie, Bjørn I Bertelsen, Øyvind Salvesen, Mari K Halle, Noeska Smit, Camilla Krakstad, Ingfrid S Haldorsen

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Abstract

Background: Effective diagnostic tools for prompt identification of high-risk locally advanced cervical cancer (LACC) patients are needed to facilitate early, individualized treatment. The aim of this work was to assess temporal changes in tumor radiomics (delta radiomics) from T2-weighted imaging (T2WI) during concurrent chemoradiotherapy (CCRT) in LACC patients, and their association with progression-free survival (PFS). Furthermore, to develop, validate, and compare delta- and pretreatment radiomic signatures for prognostic modeling.

Methods: A total of 110 LACC patients undergoing CCRT with MRI at baseline and mid-treatment were divided into training (cohort_T: n = 73) and validation (cohort_V: n = 37) cohorts. Radiomic features were extracted from tumors segmented on pre-CCRT and mid-CCRT T2WI and radiomic deltas (delta features) were computed. Two radiomic signatures for predicting PFS were constructed by least absolute shrinkage and selection operator (LASSO) Cox regression: Delta_rad (from delta features) and Pre-CCRT_rad (from pre-CCRT features). Prognostic performance of the radiomic signatures, 2018 International Federation of Gynecology and Obstetrics (FIGO) stage (I-IV), and baseline MRI-derived maximum tumor diameter (Tumor_max: ≤2 cm; >2 and ≤ 4 cm; >4 cm) was evaluated by area under time-dependent receiver operating characteristics (tdROC) curves (AUC) in cohort_T and cohort_V (AUC_T/AUC_V). Mann-Whitney U tests assessed differences in radiomic delta features. PFS was evaluated using the Kaplan-Meier method with log-rank tests.

Results: Delta_rad (AUC_T/AUC_V: 0.74/0.79) marginally outperformed Pre-CCRT_rad (0.72/0.75) for predicting 5-year PFS, and both signatures clearly surpassed that of FIGO (0.61/0.61) and Tumor_max (0.58/0.65). In total, four features within Delta_rad and Pre-CCRT_rad significantly differed in delta feature values between progressors and non-progressors, being consistently lower in progressors (p ≤ 0.03 for all). High Delta_rad and Pre-CCRT_rad radiomic scores were associated with poor PFS (p ≤ 0.04 for Delta_rad in cohort_T/Pre-CCRT_rad in both cohorts; p = 0.11 for Delta_rad in cohort_V).

Conclusions: Delta- and pretreatment radiomic signatures equally allow early prognostication in LACC, outperforming FIGO stage and MRI-assessed maximum tumor diameter.

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MRI三角放射组学在局部晚期宫颈癌放化疗中的预后评价。

背景：需要有效的诊断工具来及时识别高危局部晚期宫颈癌（LACC）患者，以促进早期个性化治疗。本研究的目的是评估LACC患者同步放化疗（CCRT）期间t2加权成像（T2WI）肿瘤放射组学（δ放射组学）的时间变化及其与无进展生存期（PFS）的关系。此外，为了开发、验证和比较用于预后建模的δ和预处理放射学特征。方法：共有110例LACC患者在基线和治疗中期接受CCRT和MRI治疗，分为训练（队列：n = 73）和验证（队列：n = 37）。从ccrt前和ccrt中期T2WI分割的肿瘤中提取放射学特征，计算放射学δ （δ特征）。通过最小绝对收缩和选择算子（LASSO） Cox回归构建了预测PFS的两个放射性特征：delta tarad（来自delta特征）和Pre-CCRTrad（来自pre-CCRT特征）。放射学特征的预后表现，2018年国际妇产科学联合会（FIGO）分期（I-IV），以及基线mri衍生的最大肿瘤直径(Tumormax:≤2cm；>2和≤4cm；在队列tt和队列tv （AUCT/AUCV）中，根据随时间变化的受试者工作特征（tdROC）曲线（AUC）的面积进行评估。曼-惠特尼U测试评估了放射性δ特征的差异。采用Kaplan-Meier法和log-rank检验评价PFS。结果：Deltarad （AUCT/AUCV: 0.74/0.79）在预测5年PFS方面略优于Pre-CCRTrad(0.72/0.75)，且两者均明显优于FIGO（0.61/0.61）和Tumormax（0.58/0.65）。总的来说，Deltarad和Pre-CCRTrad中的4个特征在进展者和非进展者之间的δ特征值存在显著差异，在进展者中δ特征值始终较低（p≤0.03）。较高的Deltarad和Pre-CCRTrad放射学评分与较差的PFS相关(两个队列中Deltarad /Pre-CCRTrad的p≤0.04；Deltarad在队列中的p = 0.11)。结论：Delta和预处理放射学特征同样可以用于LACC的早期预后，优于FIGO分期和mri评估的最大肿瘤直径。

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来源期刊

BMC Cancer 医学-肿瘤学

CiteScore

6.00

自引率

2.60%

发文量

1204

审稿时长

6.8 months

期刊介绍： BMC Cancer is an open access, peer-reviewed journal that considers articles on all aspects of cancer research, including the pathophysiology, prevention, diagnosis and treatment of cancers. The journal welcomes submissions concerning molecular and cellular biology, genetics, epidemiology, and clinical trials.