目的:评估基于CT的放射组学和血液来源的生物标志物是否可以改善接受根治性RT治疗的口鼻咽癌(OPC)患者的总生存期(OS)和局部无进展生存期(LRPFS)的预测。
方法:纳入2005年至2021年连续治疗的原发性肿瘤OPC患者。分析的临床变量包括性别,年龄,吸烟史,分期,subsite,HPV状态,和血液参数(基线血红蛋白水平,中性粒细胞,单核细胞,和血小板,和导出的测量值)。使用pyradiomics从原发性肿瘤的总肿瘤体积(GTT)中提取放射学特征。感兴趣的结果是LRPFS和OS。在选择功能之后,计算每位患者的影像组学评分(RS).重要变量,随着年龄和性别,包括在多变量分析中,如果有统计学意义,则保留模型。通过C指数比较了模型的性能。
结果:一百零五名患者,以男性为主(71%),包括在分析中。平均年龄为59岁(IQR:52-66岁),和阶段IVA是最多的代表(70%)。63例患者的HPV状态为阳性,7例阴性,35例缺失。中位OS随访时间为6.3(IQR:5.5-7.9)年。在HPV阳性亚组(p=0.038)中,低Hb水平与较差的LRPFS之间存在统计学上的显着关联。RS的计算根据OS(log-rankp<0.0001)和LRPFS(log-rankp=0.0002)成功地将患者分层。临床和影像组学模型的C指数导致OS为0.82[CI:0.80-0.84],LRPFS为0.77[CI:0.75-0.79]。
结论:我们的结果表明,在这种情况下,影像组学可以提供具有临床意义的信息内容。通过结合临床和定量成像变量获得最佳性能,因此表明在这种情况下,整合模型对患者结局预测的潜力。
OBJECTIVE: To assess whether CT-based radiomics and blood-derived biomarkers could improve the prediction of overall survival (OS) and locoregional progression-free survival (LRPFS) in patients with oropharyngeal cancer (OPC) treated with curative-intent RT.
METHODS: Consecutive OPC patients with primary tumors treated between 2005 and 2021 were included. Analyzed clinical variables included gender, age, smoking history, staging, subsite, HPV status, and blood parameters (baseline hemoglobin levels, neutrophils, monocytes, and platelets, and derived measurements). Radiomic features were extracted from the gross tumor volumes (GTVs) of the primary tumor using pyradiomics. Outcomes of interest were LRPFS and OS. Following feature selection, a radiomic score (RS) was calculated for each patient. Significant variables, along with age and gender, were included in multivariable analysis, and models were retained if statistically significant. The models\' performance was compared by the C-index.
RESULTS: One hundred and five patients, predominately male (71%), were included in the analysis. The median age was 59 (IQR: 52-66) years, and stage IVA was the most represented (70%). HPV status was positive in 63 patients, negative in 7, and missing in 35 patients. The median OS follow-up was 6.3 (IQR: 5.5-7.9) years. A statistically significant association between low Hb levels and poorer LRPFS in the HPV-positive subgroup (p = 0.038) was identified. The calculation of the RS successfully stratified patients according to both OS (log-rank p < 0.0001) and LRPFS (log-rank p = 0.0002). The C-index of the clinical and radiomic model resulted in 0.82 [CI: 0.80-0.84] for OS and 0.77 [CI: 0.75-0.79] for LRPFS.
CONCLUSIONS: Our results show that radiomics could provide clinically significant informative content in this scenario. The best performances were obtained by combining clinical and quantitative imaging variables, thus suggesting the potential of integrative modeling for outcome predictions in this setting of patients.