Abstract
Simple SummaryThe prognostic performance of traditional methodologies in advanced nasopharyngeal carcinoma does not allow to successfully stratify patients. Previous studies showed that MRI-radiomics has been used to give additional information to improve the prognosis for this type of pathology in patients from endemic areas (Asia). The purpose of this study was to use MRI-radiomics to develop prognostic models for overall survival in patients from non-endemic areas (Europe or United States). In particular, T1-weighted and T2-weighted MRI were used for the purpose. Radiomic features from those images allowed to successfully train a prognostic signature that improved the prognostic performance of models based on clinical variables alone for different clinical endpoints (overall survival, disease-free survival and loco-regional recurrence-free survival). These results suggest how MRI-radiomics is a useful additional tool for prognosis in nasopharyngeal cancer.Advanced stage nasopharyngeal cancer (NPC) shows highly variable treatment outcomes, suggesting the need for independent prognostic factors. This study aims at developing a magnetic resonance imaging (MRI)-based radiomic signature as a prognostic marker for different clinical endpoints in NPC patients from non-endemic areas. A total 136 patients with advanced NPC and available MRI imaging (T1-weighted and T2-weighted) were selected. For each patient, 2144 radiomic features were extracted from the main tumor and largest lymph node. A multivariate Cox regression model was trained on a subset of features to obtain a radiomic signature for overall survival (OS), which was also applied for the prognosis of other clinical endpoints. Validation was performed using 10-fold cross-validation. The added prognostic value of the radiomic features to clinical features and volume was also evaluated. The radiomics-based signature had good prognostic power for OS and loco-regional recurrence-free survival (LRFS), with C-index of 0.68 and 0.72, respectively. In all the cases, the addition of radiomics to clinical features improved the prognostic performance. Radiomic features can provide independent prognostic information in NPC patients from non-endemic areas.
Highlights
Nasopharyngeal carcinoma (NPC) is a malignancy with a distinct geographical distribution worldwide, commonly affecting Asian countries and rarely European countries’ populations (IR of 0.47 per 100.000 persons/year) [1]
nasopharyngeal cancer (NPC) patients, using radiomic features extracted from the main tumor and the largest lymphnode nodeinin both bothT1w
The results showed that the translatability of the signatures was dependent on the particular endpoint with good prognostic power for loco-regional recurrence-free survival (LRFS) and providing an added value for DFS when merged with clinical variables
Summary
Nasopharyngeal carcinoma (NPC) is a malignancy with a distinct geographical distribution worldwide, commonly affecting Asian countries (incidence rate, IR, up to 20–50 per 100.000 persons/year) and rarely European countries’ populations (IR of 0.47 per 100.000 persons/year) [1]. In non-endemic areas, all clinical information is commonly translated from locations where NPC is an endemic disease. Preliminary results from a large multicentric database on NPC patients in non-endemic area showed that survival was comparable to patients in endemic countries [2]. Advances in NPC management including intensity-modulated radiotherapy (IMRT) techniques and intensified chemotherapy approaches (induction and concurrent) have contributed to an improved outcome with a lowered frequency of serious radiation-induced toxicities [3,4]. Head and neck magnetic resonance imaging (MRI) is the modality of choice for loco-regionally staging of NPC [9]. MRI-based radiomics signatures turned out to significantly predict response to induction chemotherapy and survival in advanced NPC [10,11,12,13,14]
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