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Predicting event-free survival after induction of remission in high-risk pediatric neuroblastoma: combining 123I-MIBG SPECT-CT radiomics and clinical factors

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Abstract

Background

Accurately quantifying event-free survival after induction of remission in high-risk neuroblastoma can lead to better subsequent treatment decisions, including whether more aggressive therapy or milder treatment is needed to reduce unnecessary treatment side effects, thereby improving patient survival.

Objective

To develop and validate a 123I-metaiodobenzylguanidine (MIBG) single-photon emission computed tomography-computed tomography (SPECT-CT)-based radiomics nomogram and evaluate its value in predicting event-free survival after induction of remission in high-risk neuroblastoma.

Materials and methods

One hundred and seventy-two patients with high-risk neuroblastoma who underwent an 123I-MIBG SPECT-CT examination were retrospectively reviewed. Eighty-seven patients with high-risk neuroblastoma met the final inclusion and exclusion criteria and were randomized into training and validation cohorts in a 7:3 ratio. The SPECT-CT images of patients were visually analyzed to assess the Curie score. The 3D Slicer software tool was used to outline the region of interest of the lumbar 3–5 vertebral bodies on the SPECT-CT images. Radiomics features were extracted and screened, and a radiomics model was constructed with the selected radiomics features. Univariate and multivariate Cox regression analyses were used to determine clinical risk factors and construct the clinical model. The radiomics nomogram was constructed using multivariate Cox regression analysis by incorporating radiomics features and clinical risk factors. C-index and time-dependent receiver operating characteristic curves were used to evaluate the performance of the different models.

Results

The Curie score had the lowest efficacy for the assessment of event-free survival, with a C-index of 0.576 and 0.553 in the training and validation cohorts, respectively. The radiomics model, constructed from 11 radiomics features, outperformed the clinical model in predicting event-free survival in both the training cohort (C-index, 0.780 vs. 0.653) and validation cohort (C-index, 0.687 vs. 0.667). The nomogram predicted the best prognosis for event-free survival in both the training and validation cohorts, with C-indices of 0.819 and 0.712, and 1-year areas under the curve of 0.899 and 0.748, respectively.

Conclusion

123I-MIBG SPECT-CT-based radiomics can accurately predict the event-free survival of high-risk neuroblastoma after induction of remission The constructed nomogram may enable an individualized assessment of high-risk neuroblastoma prognosis and assist clinicians in optimizing patient treatment and follow-up plans, thereby potentially improving patient survival.

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Data availability

The datasets analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

The authors thank the staff of the Department of Nuclear Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China, for their selfless and valuable assistance.

Funding

This work was supported by the National Natural Science Foundation of China (No. 82102088 and 82272034).

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Authors and Affiliations

  1. Department of Nuclear Medicine, Beijing Friendship Hospital, Capital Medical University, 95 Yong An Road, Xi Cheng District, Beijing, 100050, China

    Lijuan Feng, Xu Yang, Wei Wang & Jigang Yang

  2. SinoUnion Healthcare Inc, Beijing, China

    Chao Wang

  3. Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China

    Hui Zhang

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Contributions

Conceptualization: L.F. and J.Y.; data curation: L.F. and X.Y.; formal analysis: C.W. and W.W.; funding acquisition: W.W. and J.Y.; investigation: X.Y. and C.W.; methodology: L.F., C.W., and H.Z.; project administration: J.Y.; resources: W.W. and J.Y.; software: C.W. and H.Z.; supervision: J.Y.; validation: L.F., X.Y., C.W., and W.W.; visualization: L.F., H.Z., W.W., and J.Y.; writing—original draft preparation: L.F., X.Y., C.W., H.Z., W.W., and J.Y.; writing—review and editing: L.F., X.Y., C.W., H.Z., W.W., and J.Y. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Jigang Yang.

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All procedures performed in the study were in accordance with the principles of the 1964 Declaration of Helsinki and its later amendments. This study was approved by the Institutional Review Board.

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Feng, L., Yang, X., Wang, C. et al. Predicting event-free survival after induction of remission in high-risk pediatric neuroblastoma: combining 123I-MIBG SPECT-CT radiomics and clinical factors. Pediatr Radiol 54, 805–819 (2024). https://doi.org/10.1007/s00247-024-05901-z

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