CT radiomic signature predicts survival and chemotherapy benefit in stage I and II HPV-associated oropharyngeal carcinoma.
CT radiomic signature predicts survival and chemotherapy benefit in stage I and II HPV-associated oropharyngeal carcinoma.
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DOI：
10.1038/s41698-023-00404-w
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发表时间：
2023-06-02
影响因子：
7.9
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中科院分区：
文献类型：
--
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放化疗是人类乳头瘤病毒(HPV)相关性口咽鳞状细胞癌(OPSCC)的常用治疗方案。然而，并不是所有的患者都能从化疗中受益，尤其是具有低风险特征的患者。我们的目标是开发和验证预后和预测性放射影像特征(PRI)，以利用491例与HPV相关的I期和II期OPSCC的计算机断层扫描(CT)扫描来告知生存和化疗益处，这些扫描被分为三个队列D1-D3。在两个测试集(D2，n = 162和D3，n = 269)上使用一致性指数评估PRI的预后表现。来自D2和D3的患者单独接受放射治疗或接受化疗，用来验证PRI是否可以预测化疗的额外益处。单因素分析发现，D2(危险比[HR]=2.14，95%可信区间[CI]，1.1~4.16，p = 0.02)和D3(HR = =2.74，95%CI，1.34~5.62，p = 0.006)对总生存率(OS)有预测作用。在D2(放疗与化疗，HR = 4.47，95%CI，1.73~11.6，p = 0.002)和D3(放疗与化疗，HR = 2.99，95%CI，1.04~8.63，p = 0.04)中，化疗与高PRIS患者的OS改善有关。相比之下，化疗没有改善低PRIS患者的OS，这表明这些患者没有从化疗中获得额外的好处，可以考虑降低治疗级别。拟议的放射组学特征是患者生存的预后和化疗对I期和II期HPV相关OPSCC患者的知情益处。
Chemoradiation is a common therapeutic regimen for human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma (OPSCC). However, not all patients benefit from chemotherapy, especially patients with low-risk characteristics. We aim to develop and validate a prognostic and predictive radiomic image signature (pRiS) to inform survival and chemotherapy benefit using computed tomography (CT) scans from 491 stage I and II HPV-associated OPSCC, which were divided into three cohorts D1–D3. The prognostic performance of pRiS was evaluated on two test sets (D2, n = 162; D3, n = 269) using concordance index. Patients from D2 and D3 who received either radiotherapy alone or chemoradiation were used to validate pRiS as predictive of added benefit of chemotherapy. Seven features were selected to construct pRiS, which was found to be prognostic of overall survival (OS) on univariate analysis in D2 (hazard ratio [HR] = 2.14, 95% confidence interval [CI], 1.1–4.16, p = 0.02) and D3 (HR = 2.74, 95% CI, 1.34–5.62, p = 0.006). Chemotherapy was associated with improved OS for high-pRiS patients in D2 (radiation vs chemoradiation, HR = 4.47, 95% CI, 1.73–11.6, p = 0.002) and D3 (radiation vs chemoradiation, HR = 2.99, 95% CI, 1.04–8.63, p = 0.04). In contrast, chemotherapy did not improve OS for low-pRiS patients, which indicates these patients did not derive additional benefit from chemotherapy and could be considered for treatment de-escalation. The proposed radiomic signature was prognostic of patient survival and informed benefit from chemotherapy for stage I and II HPV-associated OPSCC patients.
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