Predictive value of pretreatment MRI texture analysis in patients with primary nasopharyngeal carcinoma

Jiaji Mao,Fang Zhang,Jun Shen,Jin Fang,Xiaoyan Wu,Minghui Cao,Liejing Lu,Xiang Zhang,Zehong Yang,Yue Ding,Xiaohui Duan

doi:10.1007/s00330-018-5961-6

Abstract

ObjectivesTo determine the predictive value of pretreatment MRI texture analysis for progression-free survival (PFS) in patients with primary nasopharyngeal carcinoma (NPC).MethodsEthical approval by the institutional review board was obtained for this retrospective analysis. In 79 patients with primary NPC, texture analysis of the primary tumour was performed on pretreatment T2 and contrast-enhanced T1-weighted images (T2WIs and CE-T1WIs). The Cox proportional hazards model was used to determine the association of texture features, tumour volume and the tumour-node-metastasis (TNM) stage with PFS. Survival curves were plotted using the Kaplan-Meier method. The prognostic performance was evaluated with the receiver operating characteristic (ROC) analyses and C-index.ResultsTumour volume (hazard ratio, 1.054; 95% confidence interval [CI], 1.016–1.093) and CE-T1WI-based uniformity (hazard ratio, 0; 95% CI, 0–0.001) were identified as independent predictors for PFS (p < 0.05). Kaplan-Meier analysis showed that smaller tumour volume (less than the cut-off value, 11.699 cm3) and higher CE-T1WI-based uniformity (greater than the cut-off value, 0.856) were associated with improved PFS (p < 0.05). The combination of CE-T1WI-based uniformity with tumour volume and the overall stage predicted PFS better (area under the curve [AUC], 0.825; Cindex, 0.794) than the tumour volume (AUC, 0.659; C-index, 0.616) or the overall stage (AUC, 0.636; C-index, 0.627) did (p < 0.05).ConclusionsA texture parameter of pretreatment CE-T1WI-based uniformity improves the prediction of PFS in NPC patients.Key Points• Higher CE-T1WI-based uniformity and smaller tumour volume are predictive of improved PFS in NPC patients.• The combination of CE-T1WI-based uniformity with tumour volume and the overall stage has a better predictive ability for PFS than the tumour volume or the overall stage alone.• Pretreatment MRI texture analysis has a prognostic value for NPC patients.

Highlights

Nasopharyngeal carcinoma (NPC) is a cancer arising from the nasopharynx epithelium with a very unique geographic distribution [1]
Our study demonstrated that tumour volume and CE-T1WIbased uniformity were independent predictors for progression-free survival (PFS) in patients with NPC
Texture analysis can improve PFS prediction when combined with clinical indexes, such as tumour volume or overall stage

Summary

Introduction

Nasopharyngeal carcinoma (NPC) is a cancer arising from the nasopharynx epithelium with a very unique geographic distribution [1]. It is one of the most common malignant tumours in South-Eastern China, South-Eastern Asia and Northern Africa [2]. Several molecular biomarkers have been correlated with survival in NPC patients [5, 6] These biomarkers are obtained through randomly sampled biopsy that evaluates a small fraction of the tumour. As such, they have inherent limitations including the evaluation of invasiveness and misrepresentation of the entire tumour due to heterogeneity [7]

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Conclusion