Radiomics of rectal cancer for predicting distant metastasis and overall survival
Radiomics of rectal cancer for predicting distant metastasis and overall survival
复制标题
DOI：
10.3748/wjg.v26.i33.5008
复制
发表时间：
2020-09-07
影响因子：
4.3
通讯作者：
Song, Bin
中科院分区：
文献类型：
--
作者：
Li, Mou;Zhu, Yu-Zhou;Song, Bin
直肠癌（RC）患者按不同因素分层可能会产生不同的结果。因此，需要更有效的预后生物标志物来改善RC患者的风险分层、个性化治疗和诊断。目的建立一种新的预测RC患者远处转移和3年总生存率的模型。方法：回顾性分析了2012年10月至2015年12月期间接受根治性切除治疗的148例RC患者（76例男性和72例女性），未接受新辅助或术后放化疗。这些患者被分配到训练或验证集，比例为7：3。放射组学特征从RC的门静脉期计算机断层扫描（CT）图像中提取。最小绝对收缩和选择算子回归分析用于特征选择。多变量逻辑回归分析用于开发放射组学特征（Rad-score）和临床放射学风险模型（组合模型）。建立受试者工作特征曲线，评价模型预测RC远处转移的诊断性能。通过Kaplan-Meier生存分析研究组合模型与3年OS的相关性。结果51例（34.5%）患者发生远处转移，26例（17.6%）患者死亡，122例（82.4%）患者术后生存至少3年。在远处转移组和非转移组之间，Rad-score（由三个选定的特征组成）和组合模型的值均存在显著差异（Rad-score为0.46 +/-0.21 vs0.32 +/- 0.24，组合模型为0.60 +/-0.23 vs0.28 +/- 0.26;两种模型均P< 0.001）。组合模型中包含的预测因子包括Rad-score、病理N分期和T分期。在模型中加入组织学分级并不能显示出增加的预后价值。组合模型显示出良好的区分度，训练集和验证集的曲线下面积分别为0.842和0.802。对于生存分析，组合模型与整个队列和相应亚组的OS改善相关。结论本研究提出了一个临床放射学风险模型，可视化的诺模图，可用于促进远程转移和3年OS的RC患者的个体化预测。
BACKGROUND Rectal cancer (RC) patient stratification by different factors may yield variable results. Therefore, more efficient prognostic biomarkers are needed for improved risk stratification, personalized treatment, and prognostication of RC patients. AIM To build a novel model for predicting the presence of distant metastases and 3-year overall survival (OS) in RC patients. METHODS This was a retrospective analysis of 148 patients (76 males and 72 females) with RC treated with curative resection, without neoadjuvant or postoperative chemoradiotherapy, between October 2012 and December 2015. These patients were allocated to a training or validation set, with a ratio of 7:3. Radiomic features were extracted from portal venous phase computed tomography (CT) images of RC. The least absolute shrinkage and selection operator regression analysis was used for feature selection. Multivariate logistic regression analysis was used to develop the radiomics signature (Rad-score) and the clinicoradiologic risk model (the combined model). Receiver operating characteristic curves were constructed to evaluate the diagnostic performance of the models for predicting distant metastasis of RC. The association of the combined model with 3-year OS was investigated by Kaplan-Meier survival analysis. RESULTS A total of 51 (34.5%) patients had distant metastases, while 26 (17.6%) patients died, and 122 (82.4%) patients lived at least 3 years post-surgery. The values of both the Rad-score (consisted of three selected features) and the combined model were significantly different between the distant metastasis group and the non-metastasis group (0.46 +/- 0.21vs0.32 +/- 0.24 for the Rad-score, and 0.60 +/- 0.23vs0.28 +/- 0.26 for the combined model;P< 0.001 for both models). Predictors contained in the combined model included the Rad-score, pathological N-stage, and T-stage. The addition of histologic grade to the model failed to show incremental prognostic value. The combined model showed good discrimination, with areas under the curve of 0.842 and 0.802 for the training set and validation set, respectively. For the survival analysis, the combined model was associated with an improved OS in the whole cohort and the respective subgroups. CONCLUSION This study presents a clinicoradiologic risk model, visualized in a nomogram, that can be used to facilitate individualized prediction of distant metastasis and 3-year OS in patients with RC.