Prediction of survival of patients with cervical cancer after concurrent chemoradiotherapy based on clinical and imaging parameters
Zhang Yu1, Su Rixin1, Zhang Kaiyue1, Bo Juan1,2, Jia Haodong1,2, Qian Liting1, Dong Jiangning1,2
1Department of Radiation Oncology, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei 230001, China; 2Department of Radiology, the First Affiliated Hospital of University of Science and Technology of China, Hefei 230031, China
Abstract：Objective To investigate the value of nomograms based on clinical parameters, apparent diffusion coefficient (ADC) and MRI-derived radiomics in predicting survival of patients with locally advanced cervical cancer (LACC) after concurrent chemoradiotherapy (CCRT). Methods Clinical data of 423 patients with IB-IVA cervical cancer treated with CCRT at Anhui Provincial Hospital Affiliated to Anhui Medical University from March 2014 to March 2020 were retrospectively analyzed and randomly divided into the training and validation groups at a ratio of 2∶1 using the simple randomization method. The values of ADCmin, ADCmean, ADCmax and 3D texture parameters of diffusion weighted imaging (DWI), T2WI, T2WI-fat suppression of pre-treatment primary lesions in all patients were measured. The least absolute shrinkage and selection operator (LASSO) algorithm and logistic regression analysis were used to screen the texture features and calculate radiomics score (Rad-score). Cox regression analysis was employed to construct nomogram models for predicting overall survival (OS) and cancer-specific survival (CS) of patients with LACC after CCRT, which were subject to internal and external validation. Results Squamous cell carcinoma antigen (SCC-Ag), external beam radiotherapy dose, ADCmin and Rad-score were the independent prognostic factors for OS and CS of LACC patients after CCRT and constituted predictive models for OS and CS. The area under the receiver operating characteristic (ROC) curve (AUC) of two models in predicting 1-year, 3-year, 5-year OS and CS was 0.906, 0.917, 0.916 and 0.911, 0.918, 0.920, with internally validated consistency indexes (C-indexes) of 0.897 and 0.900. Then, models were brought into the validation group for external validation with AUC of 0.986, 0.942, 0.932 and 0.986, 0.933, 0.926 in predicting 1-year, 3-year, 5-year OS and CS. Conclusion The nomograms based on clinical parameters, ADC values and MRI-derived radiomics are of high clinical value in predicting OS and CS of patients with LACC after CCRT, which can be used as prognostic markers for patients with cervical cancer to certain extent.
Zhang Yu,Su Rixin,Zhang Kaiyue et al. Prediction of survival of patients with cervical cancer after concurrent chemoradiotherapy based on clinical and imaging parameters[J]. Chinese Journal of Radiation Oncology, 2023, 32(1): 28-35.
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2023, Vol. 32 
