基于MRI的放射组学用于早发直肠癌复发风险的分层：多中心研究
MRI-based radiomics for stratifying recurrence risk of early-onset rectal cancer: a multicenter study
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影响因子:8.3
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
DOI:
10.1016/j.esmoop.2024.103735
摘要
早发直肠癌（EORC）具有独特的疾病过程，其临床病理特征与晚发直肠癌（LORC）不同。然而，关于EORC患者复发风险的研究有限。我们旨在建立一种预测模型，以准确预测EORC的复发风险。从2012年11月至2018年11月，回顾性纳入了三家医疗机构中接受根治性手术且进行T2加权成像与弥散加权成像磁共振成像（MRI）的直肠癌患者。比较EORC与LORC之间的临床病理特征差异。基于治疗前MRI的五个辐射组学特征和临床病理变量，构建了五个疾病无生存期（DFS）预测模型。采用在训练集中计算的固定临界值，将EORC患者分为高风险和低风险组。模型性能通过一致性指数（C-index）和受试者工作特征（ROC）曲线进行评估。共纳入264例EORC患者（中位年龄43岁，男性163例）和778例LORC患者（中位年龄62岁，男性520例）。预处理时血清癌胚抗原（CEA）阳性（HR=2.84，P=0.006）、病理学阳性淋巴结状态（pN阳性）（HR=2.86，P=0.011）及MRI辐射组学评分（HR=2.72，P<0.001）为EORC患者疾病无生存期的独立风险因素。将临床病理特征与MRI辐射组学特征整合的EORC-ClinPathRadiom模型，在训练、内部和外部验证集中显示出C-index分别为0.82、0.82和0.81。该模型有效将EORC患者分为高风险和低风险两组（训练集、内部验证集和外部验证集的HR分别为8.96、6.81和7.46）。EORC-ClinPathRadiom模型可以有效预测并分层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.