MRI-based radiomic signatures for pretreatment prognostication in cervical cancer

Abstract

Background

Accurate pretherapeutic prognostication is important for tailoring treatment in cervical cancer (CC). Purpose

To investigate whether pretreatment MRI-based radiomic signatures predict disease-specific survival (DSS) in CC. Study Type

Retrospective. Population

CC patients (n = 133) allocated into training(T) (nT = 89)/validation(V) (nV = 44) cohorts. Field Strength/Sequence

T2-weighted imaging (T2WI) and diffusion-weighted imaging (DWI) at 1.5T or 3.0T. Assessment

Radiomic features from segmented tumors were extracted from T2WI and DWI (high b-value DWI and apparent diffusion coefficient (ADC) maps). Statistical Tests

Radiomic signatures for prediction of DSS from T2WI (T2rad) and T2WI with DWI (T2 + DWIrad) were constructed by least absolute shrinkage and selection operator (LASSO) Cox regression. Area under time-dependent receiver operating characteristics curves (AUC) were used to evaluate and compare the prognostic performance of the radiomic signatures, MRI-derived maximum tumor size ≤/> 4 cm (MAXsize), and 2018 International Federation of Gynecology and Obstetrics (FIGO) stage (I–II/III–IV). Survival was analyzed using Cox model estimating hazard ratios (HR) and Kaplan–Meier method with log-rank tests. Results

The radiomic signatures T2rad and T2 + DWIrad yielded AUCT/AUCV of 0.80/0.62 and 0.81/0.75, respectively, for predicting 5-year DSS. Both signatures yielded better or equal prognostic performance to that of MAXsize (AUCT/AUCV: 0.69/0.65) and FIGO (AUCT/AUCV: 0.77/0.64) and were significant predictors of DSS after adjusting for FIGO (HRT/HRV for T2rad: 4.0/2.5 and T2 + DWIrad: 4.8/2.1). Adding T2rad and T2 + DWIrad to FIGO significantly improved DSS prediction compared to FIGO alone in cohort(T) (AUCT 0.86 and 0.88 vs. 0.77), and FIGO with T2 + DWIrad tended to the same in cohort(V) (AUCV 0.75 vs. 0.64, p = 0.07). High radiomic score for T2 + DWIrad was significantly associated with reduced DSS in both cohorts.