Abstract
Prognostic parameters and models were believed to be helpful in improving the treatment outcome for patients with brain metastasis (BM). The purpose of this study was to investigate the feasibility of computer tomography (CT) radiomics based nomogram to predict the survival of patients with BM from non-small cell lung cancer (NSCLC) treated with whole brain radiotherapy (WBRT). A total of 195 patients with BM from NSCLC who underwent WBRT from January 2012 to December 2016 were retrospectively reviewed. Radiomics features were extracted and selected from pretherapeutic CT images with least absolute shrinkage and selection operator (LASSO) regression. A nomogram was developed and evaluated by integrating radiomics features and clinical factors to predict the survival of individual patient. Five radiomics features were screened out from 105 radiomics features according to the LASSO Cox regression. According to the optimal cutoff value of radiomics score (Rad-score), patients were stratified into low-risk (Rad-score <= −0.14) and high-risk (Rad-score > −0.14) groups. Multivariable analysis indicated that sex, karnofsky performance score (KPS) and Rad-score were independent predictors for overall survival (OS). The concordance index (C-index) of the nomogram in the training cohort and validation cohort was 0.726 and 0.660, respectively. An area under curve (AUC) of 0.786 and 0.788 was achieved for the short-term and long-term survival prediction, respectively. In conclusion, the nomogram based on radiomics features from CT images and clinical factors was feasible to predict the OS of BM patients from NSCLC who underwent WBRT.
Highlights
Brain metastasis (BM) is the most frequent intracranial malignancy and remains a leading cause of morbidity and mortality in both men and woman despite advances in surgical, systemic, and radiotherapy treatments [1]
The purpose of this study is to investigate the feasibility and sensitivity of computer tomography (CT) radiomics based nomogram to predict the survival of patients with brain metastasis (BM) from non-small cell lung cancer (NSCLC) treated with whole brain radiotherapy (WBRT)
The including criteria were 1) BM metastasized from original NSCLC; 2) BM treated with WBRT; 3) The number of metastases is less than ten; 4) Patients with pretherapeutic contrast enhanced CT (CECT) images
Summary
Brain metastasis (BM) is the most frequent intracranial malignancy and remains a leading cause of morbidity and mortality in both men and woman despite advances in surgical, systemic, and radiotherapy treatments [1]. Studies indicated that the prognosis of individual BM patients may be affected by a few clinical factors, such as the type of primary cancer, systemic control, treatment modality, treatment response, etc [4, 5]. The identification of these prognostic factors before or early after the beginning of treatment was believed to be helpful in improving the treatment outcome for patients with BM by adjusting and choosing the right management strategy [6]. Several prognostic models had been suggested to predict the survival of BM patients [7,8,9] Prognostic models such as Golden Grading System (GGS), Disease-Specific Graded Prognostic Assessment (DSGPA), Score Index for Radiosurgery (SIR) in brain metastases, etc. Studies pointed out core biopsy specimens may not represent the entirety of the tumor due to the spatial heterogeneity of tumors [16, 17]
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