Abstract
BackgroundThe depth of cervical stromal invasion is one of the important prognostic factors affecting decision-making for early stage cervical cancer (CC). This study aimed to develop and validate a T2-weighted imaging (T2WI)-based radiomics model and explore independent risk factors (factors with statistical significance in both univariate and multivariate analyses) of middle or deep stromal invasion in early stage CC.MethodsBetween March 2017 and March 2021, a total of 234 International Federation of Gynecology and Obstetrics IB1-IIA1 CC patients were enrolled and randomly divided into a training cohort (n = 188) and a validation cohort (n = 46). The radiomics features of each patient were extracted from preoperative sagittal T2WI, and key features were selected. After independent risk factors were identified, a combined model and nomogram incorporating radiomics signature and independent risk factors were developed. Diagnostic accuracy of radiologists was also evaluated.ResultsThe maximal tumor diameter (MTD) on magnetic resonance imaging was identified as an independent risk factor. In the validation cohort, the radiomics model, MTD, and combined model showed areas under the curve of 0.879, 0.844, and 0.886. The radiomics model and combined model showed the same sensitivity and specificity of 87.9% and 84.6%, which were better than radiologists (sensitivity, senior = 75.7%, junior = 63.6%; specificity, senior = 69.2%, junior = 53.8%) and MTD (sensitivity = 69.7%, specificity = 76.9%).ConclusionMRI-based radiomics analysis outperformed radiologists for the preoperative diagnosis of middle or deep stromal invasion in early stage CC, and the probability can be individually evaluated by a nomogram.
Highlights
Cervical cancer (CC) constitutes a heavy burden on women’s health globally
The treatment for early stage (2018 International Federation of Gynecology and Obstetrics (FIGO) IB-IIA) CC includes surgery and primary chemoradiotherapy, and the determination of treatment strategies is largely dependent on tumor-related prognostic factors [3, 4], including the depth of cervical stromal invasion (DOI) [5, 6]
Most patients with middle or deep 1/3 stromal invasion are usually treated with radical hysterectomy and adjuvant radiotherapy, especially in the presence of other risk factors, such as special pathological types, lymphovascular space invasion, or a large tumor size [3, 9]
Summary
Cervical cancer (CC) constitutes a heavy burden on women’s health globally It is the fourth most frequently occurring female malignancy and the fourth most common cause of cancer-related deaths. Most patients with middle or deep 1/3 stromal invasion are usually treated with radical hysterectomy and adjuvant radiotherapy, especially in the presence of other risk factors, such as special pathological types (adenocarcinoma, adenosquamous carcinoma, and neuroendocrine carcinoma, etc.), lymphovascular space invasion, or a large tumor size [3, 9]. Concurrent radiochemotherapy is recommended over surgery for patients with middle or deep 1/3 stromal invasion and risk factors mentioned above, as it can achieve equal treatment efficacy with the combination of radical hysterectomy and adjuvant radiotherapy, and can avoid surgery-related adverse effects [5, 10,11,12]. This study aimed to develop and validate a T2-weighted imaging (T2WI)based radiomics model and explore independent risk factors (factors with statistical significance in both univariate and multivariate analyses) of middle or deep stromal invasion in early stage CC
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