Radiomics Approach Outperforms Diameter Criteria for Predicting Pathological Lateral Lymph Node Metastasis After Neoadjuvant (Chemo)Radiotherapy in Advanced Low Rectal Cancer
Radiomics Approach Outperforms Diameter Criteria for Predicting Pathological Lateral Lymph Node Metastasis After Neoadjuvant (Chemo)Radiotherapy in Advanced Low Rectal Cancer
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DOI：
10.1245/s10434-020-08974-w
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发表时间：
2020-08-07
影响因子：
3.7
通讯作者：
Kuroyanagi, Hiroya
中科院分区：
文献类型：
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作者：
Nakanishi, Ryota;Akiyoshi, Takashi;Kuroyanagi, Hiroya
背景：进展期低位直肠癌在新辅助（化疗）放疗和全直肠系膜切除术后有不可忽视的盆腔外侧淋巴结（LPLN）转移（LPLNM）和外侧局部复发（LR）风险。LPLN剥离（LPLND）减少LR，但增加术后并发症和性/泌尿功能障碍。目的本研究的目的是开发一种新的基于放射学的直肠癌患者LPLNM预测模型。方法回顾性分析247例直肠癌伴扩大LPLN患者的临床资料。LPLN放射组学特征从预处理门静脉期计算机断层扫描图像中提取。基于175例患者的主要队列中的最小绝对收缩和选择操作员回归构建LPLN的放射组学评分。模型的性能进行了评估的歧视，校准和决策曲线分析，并在72例患者的外部验证。结果与治疗前短轴直径测量值相比，放射组学评分在主要队列（曲线下面积[AUC] 0.91 vs.0.83，p = 0.0015）和验证队列（AUC 0.90 vs.0.80，p = 0.0298）中显示出显著更好的区分度。决策曲线分析也表明放射组学评分的优越性。在对短轴直径>= 7 mm的患者进行的亚组分析中，放射组学诺模图，结合放射组学评分和LPLN收缩，
Background Advanced low rectal cancer has a non-negligible risk of lateral pelvic lymph node (LPLN) metastasis (LPLNM) and lateral local recurrence (LR) after neoadjuvant (chemo)radiotherapy and total mesorectal excision. LPLN dissection (LPLND) reduces LR but increases postoperative complications and sexual/urinary dysfunction. Objective The aim of this study was to develop a new radiomics-based prediction model for LPLNM in patients with rectal cancer. Methods A total of 247 patients with rectal cancer and enlarged LPLNs treated by (chemo)radiotherapy and LPLND were enrolled in this retrospective, multicenter study. LPLN radiomic features were extracted from pretreatment portal venous-phase computed tomography images. A radiomics score of LPLN was constructed based on the least absolute shrinkage and selection operator regression in a primary cohort of 175 patients. Model performance was assessed in terms of discrimination, calibration, and decision curve analysis, and was externally validated in 72 patients. Results The radiomics score showed significantly better discrimination compared with pretreatment short-axis diameter measurements in both the primary (area under the curve [AUC] 0.91 vs. 0.83,p = 0.0015) and validation (AUC 0.90 vs. 0.80,p = 0.0298) cohorts. Decision curve analysis also indicated the superiority of the radiomics score. In a subanalysis of patients with a short-axis diameter >= 7 mm, the radiomics nomogram, incorporating the radiomics score and LPLN shrinkage to