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MRI radiomics features of mesorectal fat can predict response to neoadjuvant chemoradiation therapy and tumor recurrence in patients with locally advanced rectal cancer

  • Oncology
  • Published:
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Abstract

Objective

To interrogate the mesorectal fat using MRI radiomics feature analysis in order to predict clinical outcomes in patients with locally advanced rectal cancer.

Methods

This retrospective study included patients who underwent neoadjuvant chemoradiotherapy for locally advanced rectal cancer from 2009 to 2015. Three radiologists independently segmented mesorectal fat on baseline T2-weighted axial MRI. Radiomics features were extracted from segmented volumes and calculated using CERR software, with adaptive synthetic sampling being employed to combat large class imbalances. Outcome variables included pathologic complete response (pCR), local recurrence, distant recurrence, clinical T-category (cT), post-treatment T category (ypT), and post-treatment N category (ypN). A maximum of eight most important features were selected for model development using support vector machines and fivefold cross-validation to predict each outcome parameter via elastic net regularization. Diagnostic metrics of the final models were calculated, including sensitivity, specificity, PPV, NPV, accuracy, and AUC.

Results

The study included 236 patients (54 ± 12 years, 135 men). The AUC, sensitivity, specificity, PPV, NPV, and accuracy for each clinical outcome were as follows: for pCR, 0.89, 78.0%, 85.1%, 52.5%, 94.9%, 83.9%; for local recurrence, 0.79, 68.3%, 80.7%, 46.7%, 91.2%, 78.3%; for distant recurrence, 0.87, 80.0%, 88.4%, 58.3%, 95.6%, 87.0%; for cT, 0.80, 85.8%, 56.5%, 89.1%, 49.1%, 80.1%; for ypN, 0.74, 65.0%, 80.1%, 52.7%, 87.0%, 76.3%; and for ypT, 0.86, 81.3%, 84.2%, 96.4%, 46.4%, 81.8%.

Conclusion

Radiomics features of mesorectal fat can predict pathological complete response and local and distant recurrence, as well as post-treatment T and N categories.

Key Points

• Mesorectal fat contains important prognostic information in patients with locally advanced rectal cancer (LARC).

• Radiomics features of mesorectal fat were significantly different between those who achieved complete vs incomplete pathologic response (accuracy 83.9%, 95% CI: 78.6–88.4%).

• Radiomics features of mesorectal fat were significantly different between those who did vs did not develop local or distant recurrence (accuracy 78.3%, 95% CI: 72.0–83.7% and 87.0%, 95% CI: 81.6–91.2% respectively).

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Abbreviations

AUC:

Area under the curve

CAPOX:

Capecitabine and oxaliplatin

cN :

Clinical nodal category

cT:

Clinical T category

DSCs:

Dice similarity coefficients

FLOX:

Fluorouracil/leucovorin and biweekly oxaliplatin

ICC:

Intra-class correlation coefficients

LARC:

Locally advanced rectal cancer

MRI:

Magnetic resonance imaging

NPV:

Negative predictive value

pCR :

Pathologic complete response

PPV:

Predictive value

SVM:

Support vector machines

TNT:

Total neoadjuvant treatment

ypN:

Post TNT nodal category

ypT :

Post TNT tumor category

ypTNM:

Post TNT TNM Stage

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Acknowledgements

The authors thank Joanne Chin, MFA, ELS, for her editorial support of this article.

Funding

This study has received funding by the NIH/NCI Cancer Center Support Grant P30 CA008748.

Author information

Author notes

  1. Vetri Sudar Jayaprakasam and Viktoriya Paroder contributed equally to this work.

Authors and Affiliations

  1. Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, Box 29, New York, NY, 10065, USA

    Vetri Sudar Jayaprakasam, Viktoriya Paroder, Peter Gibbs, Raazi Bajwa, Natalie Gangai, Ramon E. Sosa, Iva Petkovska, Jennifer S. Golia Pernicka, James Louis Fuqua III, David D. B. Bates & Marc J. Gollub

  2. Colorectal Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA

    Martin R. Weiser

  3. Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA

    Andrea Cercek

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  1. Vetri Sudar Jayaprakasam
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Corresponding author

Correspondence to Viktoriya Paroder.

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Guarantor

The scientific guarantor of this publication is Viktoriya Paroder, MD, PhD.

Conflict of interest

The authors of this manuscript declare relationships with the following companies: Dr. Andrea Cercek reports being on the advisory board of Bayer and Array Biopharma and she has received research funding from Tesaro/GSK, RGenix, and Seattle Genetics.

The remaining authors report no potential conflict of interest.

Statistics and biometry

One of the authors has significant statistical expertise —Peter Gibbs.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• retrospective

• observational

• performed at one institution

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Jayaprakasam, V.S., Paroder, V., Gibbs, P. et al. MRI radiomics features of mesorectal fat can predict response to neoadjuvant chemoradiation therapy and tumor recurrence in patients with locally advanced rectal cancer. Eur Radiol 32, 971–980 (2022). https://doi.org/10.1007/s00330-021-08144-w

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