基于MRI的放射素学用于分层早期发作直肠癌的复发风险：一项多中心研究
MRI-based radiomics for stratifying recurrence risk of early-onset rectal cancer: a multicenter study
影响因子:8.30000
分区:医学1区 Top / 肿瘤学2区
发表日期:2024 Oct
作者:
P-Y Xie, Z-M Zeng, Z-H Li, K-X Niu, T Xia, D-C Ma, S Fu, J-Y Zhu, B Li, P Zhu, S-D Xie, X-C Meng
摘要
与晚期发作直肠癌（LORC）相比，早发性直肠癌（EORC）的特征是具有不同临床病理学特征的独特疾病过程。但是，对EORC患者复发风险的研究是有限的。我们旨在开发一个预测模型，以准确预测EORC复发风险。进行激进手术和T2加权成像和扩散加权成像磁共振成像（MRI）的患者是从2012年11月至2018年11月的三个医疗机构中追溯招募的。基于临床病理变量和EORC预处理MRI的五个放射素特征构建了五个无病生存的预测模型。在训练集中计算的固定截止值用于将EORC患者分为高风险和低风险的术后复发组。通过一致指数（C-INDEX）和接收器操作特征曲线评估模型性能。总共招募了264名EORC患者（中位年龄，43岁，163名男性）和778名LORC患者（中位年龄，62岁，520名男性）。预处理阳性癌症抗原[危险比（HR）= 2.84，p = 0.006]，病理阳性淋巴结状态（PN阳性）[HR = 2.86，P = 0.011]和基于MRI的放射线放射线分数[HR = 2.72，P <0.001]是对疾病无用的患者的独立风险。通过整合EORC的临床病理学特征和基于MRI的放射线特征，在训练，内部和外部测试集中，C-指数分别为0.82、0.82和0.81。该模型有效地将EORC患者分层为高风险和低复发风险（培训，内部和外部测试组的HRS分别为8.96、6.81和7.46）。EORC-Clinpathradiom模型可以有效地预测和分层EORC患者的术后复发风险。
Abstract
Early-onset rectal cancer (EORC) is characterized by a unique disease process with different clinicopathological features compared with late-onset rectal cancer (LORC). Research on the risk of recurrence in EORC patients, however, is limited. We aim to develop a predictive model to accurately predict EORC recurrence risk.Rectal cancer patients who underwent radical surgery and T2-weighted imaging and diffusion-weighted imaging magnetic resonance imaging (MRI) were retrospectively enrolled from three medical institutions from November 2012 to November 2018. Differences in clinicopathological characteristics between EORC and LORC were compared. Five prediction models for disease-free survival were constructed based on clinicopathological variables and five radiomic features from pretreatment MRI of the EORC. A fixed cut-off value calculated in the training set was used to stratify EORC patients into high-risk and low-risk groups of post-operative recurrence. Model performance was evaluated by concordance index (C-index) and receiver operating characteristic curve.A total of 264 EORC patients (median age, 43 years, 163 males) and 778 LORC patients (median age, 62 years, 520 males) were enrolled. Pretreatment positive carcinoembryonic antigen [hazard ratio (HR) = 2.84, P = 0.006], pathological positive lymph node status (pN positive) [HR = 2.86, P = 0.011] and MRI-based radiomics score [HR = 2.72, P < 0.001] are independent risk factors for disease-free survival in EORC patients. The EORC-ClinPathRadiom model, constructed by integrating the clinicopathological characteristics and MRI-based radiomics features of EORC, showed C-index of 0.82, 0.82, and 0.81 in the training, internal, and external test sets, respectively. This model effectively stratified EORC patients into high risk and low risk of recurrence (HRs for the training, internal, and external test sets were 8.96, 6.81, and 7.46, respectively).The EORC-ClinPathRadiom model can effectively predict and stratify the risk of post-operative recurrence in EORC patients.