Abstract
PurposeWe developed and validated a CT-based radiomics nomogram to predict HER2 status in patients with adenocarcinoma of esophagogastric junction (AEG).MethodA total of 101 patients with HER2-positive (n=46) and HER2-negative (n=55) esophagogastric junction adenocarcinoma (AEG) were retrospectively analyzed. They were then randomly divided into a training cohort (n=70) and a verification cohort (n=31). The radiomics features were obtained from the portal phase of the CT enhanced scan. We used the least absolute shrinkage and selection operator (LASSO) logistic regression method to select the best radiomics features in the training cohort, combined them linearly, and used the radiomics signature formula to calculate the radiomics score (Rad-score) of each AEG patient. A multivariable logistic regression method was applied to develop a prediction model that incorporated the radiomics signature and independent risk predictors. The prediction performance of the nomogram was evaluated using the training and validation cohorts.ResultIn the training (P<0.001) and verification groups (P<0.001), the radiomics signature combined with seven radiomics features was significantly correlated with HER2 status. The nomogram composed of CT-reported T stage and radiomics signature showed very good predictive performance for HER2 status. The area under the curve (AUC) of the training cohort was 0.946 (95% CI: 0.919–0.973), and that of the validation group was 0.903 (95% CI: 0.847–0.959). The calibration curve of the radiomics nomogram showed a good degree of calibration. Decision-curve analysis revealed that the radiomics nomogram was useful.ConclusionThe nomogram CT-based radiomics signature combined with CT-reported T stage can better predict the HER2 status of AEG before surgery. It can be used as a non-invasive prediction tool for HER2 status and is expected to guide clinical treatment decisions in clinical practice, and it can assist in the formulation of individualized treatment plans.
Highlights
Adenocarcinoma of the esophagogastric junction (AEG) is a type of adenocarcinoma located at the junction of the distal end of the esophagus and the proximal end of the gastric cardia, independent of gastric cancer and esophageal cancer [1, 2]
The inclusion criteria were as follows: 1) postoperative pathologically confirmed AEG [AEG according to the diagnostic criteria of the 8th edition of the American Joint Committee on Cancer (AJCC) Cancer Staging Manual [15]]; 2) enhanced CT of the upper abdomen or the whole abdomen performed within one month before gastrectomy; 3) the postoperative pathological tissue underwent IHC detection to evaluate the HER2 status; and 4) no radiotherapy or chemotherapy before surgery
The CT-reported T stage was integrated into the nomogram with the radiomics signature in the training cohort (Figure 3)
Summary
Adenocarcinoma of the esophagogastric junction (AEG) is a type of adenocarcinoma located at the junction of the distal end of the esophagus and the proximal end of the gastric cardia, independent of gastric cancer and esophageal cancer [1, 2]. The incidence of distal gastric cancer and proximal esophageal cancer has decreased, but the incidence of AEG continues to increase. Surgical resection is the only radical cure for AEG, but surgical treatment alone is not effective for the prognosis of AEG, resulting in a low postoperative overall survival rate and a high tumor recurrence rate. Surgical resection combined with perioperative comprehensive treatment is the main treatment plan for improving the overall survival rate after AEG [3]. Van et al [4] found that AEG had a worse prognosis than esophageal cancer and distal gastric cancer, and there were significant differences in biological behavior between AEG and the two cancer
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