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Nomograms Combining Clinical and Imaging Parameters to Predict Recurrence and Disease-free Survival After Concurrent Chemoradiotherapy in Patients With Locally Advanced Cervical Cancer

  • Author Footnotes
    1 Yu Zhang and Long Liu contributed equally to the work.
    Yu Zhang
    Footnotes
    1 Yu Zhang and Long Liu contributed equally to the work.
    Affiliations
    Department of Radiation Oncology, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, Anhui, 230001, China
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  • Author Footnotes
    1 Yu Zhang and Long Liu contributed equally to the work.
    Long Liu
    Footnotes
    1 Yu Zhang and Long Liu contributed equally to the work.
    Affiliations
    Department of Hepatobiliary Surgery, Taizhou Hospital of Zhejiang University, Taizhou, Zhejiang, China
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  • Kaiyue Zhang
    Affiliations
    Department of Radiation Oncology, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, Anhui, 230001, China
    Search for articles by this author
  • Rixin Su
    Affiliations
    Department of Radiation Oncology, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, Anhui, 230001, China
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  • Haodong Jia
    Affiliations
    Department of Radiation Oncology, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, Anhui, 230001, China

    Department of Radiology, the First Affiliated Hospital of University of Science and Technology of China, Hefei, Anhui, China
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  • Author Footnotes
    2 Liting Qian and Jiangning Dong contributed equally to the work.
    Liting Qian
    Footnotes
    2 Liting Qian and Jiangning Dong contributed equally to the work.
    Affiliations
    Department of Radiation Oncology, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, Anhui, 230001, China
    Search for articles by this author
  • Author Footnotes
    2 Liting Qian and Jiangning Dong contributed equally to the work.
    Jiangning Dong
    Correspondence
    Address correspondence to: J.D.
    Footnotes
    2 Liting Qian and Jiangning Dong contributed equally to the work.
    Affiliations
    Department of Radiation Oncology, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, Anhui, 230001, China

    Department of Radiology, the First Affiliated Hospital of University of Science and Technology of China, Hefei, Anhui, China
    Search for articles by this author
  • Author Footnotes
    1 Yu Zhang and Long Liu contributed equally to the work.
    2 Liting Qian and Jiangning Dong contributed equally to the work.
Published:August 30, 2022DOI:https://doi.org/10.1016/j.acra.2022.08.002

      Purposes

      To investigate the value of nomograms based on clinical prognostic factors (CPF), intravoxel incoherent motion diffusion weighted imaging (IVIM-DWI) and MRI-derived radiomics in predicting recurrence and disease-free survival (DFS) after concurrent chemoradiotherapy (CCRT) for locally advanced cervical cancer (LACC).

      Methods

      Retrospective analysis of data from 115 patients with ⅠB-ⅣA cervical cancer who underwent CCRT and had been followed up consistently. All patients were randomized 2:1 into training and validation groups. Pre-treatment IVIM-DWI parameters (ADC-value, D-value, D*-value and f-value) and pre- and post-treatment three-dimensional radiomics parameters (from axial T2WI) of primary lesions were measured. The LASSO algorithm and Logistic regression analysis were used to filter texture features and calculate radiomics score (Rad-score). Multivariate Logistic and Cox regression analysis was used to construct nomograms to predict recurrence and DFS for patients with LACC after CCRT respectively, with internal and external validation.

      Results

      External beam radiotherapy dose, f-value, pre-treatment and post-treatment Rad-score were independent prognostic factors for recurrence and DFS in patients with cervical cancer, forming Model1 and Model2, with OR values of 0.480, 1.318, 3.071, 3.200 and HR values of 0.322, 3.372, 5.138, 7.204. The area under the curve (AUC) of Model1 for predicting recurrence of cervical cancer was 0.977, with internal and external validation C-indexes of 0.977 and 0.962. The AUC for Model2 predicting disease-free survival (DFS) at 1, 3, and 5 years was 0.895, 0.888 and 0.916 respectively, with internal and external C-indexes of 0.860 and 0.892. The decision curves analysis and clinical impact curves further indicate the high predictive efficiency and stability of nomograms.

      Conclusion

      The nomograms based on clinical, IVIM-DWI and radiomics parameters have high clinical value in predicting recurrence and DFS of patients with LACC after CCRT and can provide a reference for prognostic assessment and individualized treatment of cervical cancer patients.

      Key Words

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