Radiomic Signature of Computed Tomography Imaging for Prediction of Survival and Chemotherapeutic Benefits in Gastric Cancer

Abstract

To develop and validate a radiomics signature for prediction of gastric cancer (GC) survival and chemotherapeutic benefits. In this multicenter retrospective analysis, we analyzed radiomics features of portal venous-phase computed tomography in 1,591 consecutive patients. A radiomics signature was generated by using the Lasso-Cox regression model in 228 patients and validated in internal and external validation cohorts. Radiomics nomograms integrating the radiomics signature were constructed, demonstrating the incremental value of the radiomics signature to the traditional staging system for individualized survival estimation. The performance of the nomograms was assessed with respect to calibration, discrimination, and clinical usefulness. The radiomics signature consisted of 19 selected features and was significantly associated with DFS and OS. Multivariate analysis demonstrated that the radiomics signature was an independent prognostic factor. Incorporating the radiomics signature into the radiomics-based nomograms resulted in better performance for the estimation of DFS than the clinicopathologic nomograms and the TNM staging system, with improved accuracy of the classification of survival outcomes. Further analysis showed stage II and III patients with higher radiomics scores exhibited a favorable response to chemotherapy. In conclusion, the newly developed radiomics signature was a powerful predictor of OS and DFS. Moreover, the radiomics signature could predict which patients with stage II and III GC benefit from chemotherapy. Funding Statement: This work was supported by grants from: National Natural Science Foundation of China 81672446, 81600510, 81370575, 81570593. Natural Science Foundation of Guangdong Province, 2014A030313131. Science and Technology Planning Project of Guangzhou, 2014B020228003, 2014B030301041, 2015A030312013. Science and Technology Program of Guangzhou, 158100076, 201400000001-3. Public welfare in Health Industry, National Health and Family Planning Commission of China (201402015, 201502039). Key Clinical Specialty Discipline Construction Program. Declaration of Interests: The author(s) indicated no potential conflicts of interest. Ethics Approval Statement: Ethical approval was obtained for this retrospective analysis at every participating center, and the informed consent requirement was waved.