Abstract
BackgroundThis study aimed to evaluate the predictive potential of contrast-enhanced computed tomography (CT)-based imaging biomarkers (IBMs) for the treatment outcomes of patients with oesophageal squamous cell carcinoma (OSCC) after definitive concurrent chemoradiotherapy (CCRT).MethodsAltogether, 154 patients with OSCC who underwent definitive CCRT were included in this retrospective study. All patients were randomised to the training cohort (n = 99) or the validation cohort (n = 55). Pre-treatment contrast-enhanced CT scans were obtained for all patients and used for the extraction of IBMs. An IBM score, was constructed by using the least absolute shrinkage and selection operator with Cox regression analysis, which was equal to the log-partial hazard of the Cox model in the training cohort and tested in the validation cohort. IBM nomograms were built based on IBM scores for individualised survival estimation. Finally, a decision curve analysis was performed to estimate the clinical usefulness of the nomograms.ResultsAltogether, 96 IBMs were extracted from each contrast-enhanced CT scan. IBM scores were constructed from 11 CT-based IBMs for overall survival (OS) and 8 IBMs for progression-free survival (PFS), using the LASSO-Cox regression method in the training cohort. Multivariate analysis revealed that IBM score was an independent prognostic factor correlated with OS and PFS. In the training cohort, the C-indices of IBM scores were 0.734 (95% CI 0.664–0.804) and 0.658 (95% CI 0.587–0.729) for OS and PFS, respectively. In the validation cohort, C-indices were 0.672 (95% CI 0.578–0.766) and 0.666 (95% CI 0.574–0.758) for OS and PFS, respectively. Kaplan–Meier survival analysis showed a significant difference between risk subgroups in the training and validation cohorts. Decision curve analysis confirmed the clinical usefulness of the IBM score.ConclusionsThe IBM score based on pre-treatment contrast-enhanced CT could predict the OS and PFS for patients with OSCC after definitive CCRT. Further multicentre studies with larger sample sizes are warranted.
Highlights
This study aimed to evaluate the predictive potential of contrast-enhanced computed tomography (CT)-based imaging biomarkers (IBMs) for the treatment outcomes of patients with oesophageal squamous cell carcinoma (OSCC) after definitive concurrent chemoradiotherapy (CCRT)
Performance of IBM score In the training cohort, we evaluated the predictive accuracy of the IBM score using receiver operating characteristic (ROC) analysis at different time points of follow-up
This study showed that IBMs from contrast-enhanced CT images might allow prediction of overall survival (OS) and progression-free survival (PFS) for OSCC patients
Summary
This study aimed to evaluate the predictive potential of contrast-enhanced computed tomography (CT)-based imaging biomarkers (IBMs) for the treatment outcomes of patients with oesophageal squamous cell carcinoma (OSCC) after definitive concurrent chemoradiotherapy (CCRT). Zeng et al Radiat Oncol (2021) 16:8 multidisciplinary therapy, including definitive concurrent chemoradiotherapy (CCRT), which is the main standard treatment for oesophageal squamous cell carcinoma (OSCC) for medically unresectable tumours; and is an option for resectable tumours. Patients with higher mortality risk following CCRT may benefit from more intensive primary treatment (e.g., planned radical surgery after CCRT), adjuvant therapy (e.g. chemotherapy), or more frequent follow-up. The application of these strategies requires the identification of patients with high mortality risk prospectively to achieve personalised management. To improve the overall survival of patients with OC after CCRT, it is crucial to predict the mortality risk of each individual patient
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