Abstract
Objectives
To establish and validate a predictive model integrating with clinical and dual-energy CT (DECT) variables for individual recurrence-free survival (RFS) prediction in early-stage glottic laryngeal cancer (EGLC) after larynx-preserving surgery.
Methods
This retrospective study included 212 consecutive patients with EGLC who underwent DECT before larynx-preserving surgery between January 2015 and December 2018. Using Cox proportional hazard regression model to determine independent predictors for RFS and presented on a nomogram. The model’s performance was assessed using Harrell’s concordance index (C-index), time-dependent area under curve (TD-AUC) plot, and calibration curve. A risk stratification system was established using the nomogram with median scores of all cases to divide all patients into two prognostic groups.
Results
Recurrence occurred in 39/212 (18.4%) cases. Normalized iodine concentration in arterial (NICAP) and venous phases (NICVP) were verified as significant predictors of RFS in multivariate Cox regression (hazard ratio [HR], 4.2; 95% confidence interval [CI]: 2.3, 7.7, p < .001 and HR, 3.0; 95% CI: 1.5, 5.9, p = .002, respectively). Nomogram based on clinical and DECT variables was better than did only clinical variables. The prediction model proved well-calibrated and had good discriminative ability in the training and validation samples. A risk stratification system was built that could effectively classify EGLC patients into two risk groups.
Conclusions
DECT could provide independent RFS indicators in patients with EGLC, and the nomogram based on DECT and clinical variables was useful in predicting RFS at several time points.
Key Points
• Dual-energy CT(DECT) variables can predict recurrence-free survival (RFS) after larynx-preserving surgery in patients with early-stage glottic laryngeal cancer (EGLC).
• The model that integrates clinical and DECT variables predicted RFS better than did only clinical variables.
• A risk stratification system based on the nomogram could effectively classify EGLC patients into two risk groups.
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Abbreviations
- ART:
-
Adjuvant radiotherapy
- EGLC:
-
Early-stage glottic laryngeal cancer
- IC:
-
Iodine concentration
- IO:
-
Iodine overlay
- NIC:
-
Normalized iodine concentration
- RFS:
-
Recurrence-free survival
- VNC:
-
Virtual non-contrast
- WA:
-
Weighted average
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Acknowledgements
We thank Dr. Xionggang Yang for editorial assistance and help in the design of experiments. We also thank Dr. Yana Dou for her contribution to the technical aspects of this study.
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The scientific guarantor of this publication is Shuang Xia.
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The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.
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Fengyue Tian and Wenfei Li kindly provided statistical advice for this manuscript.
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Written informed consent was waived by the Institutional Review Board.
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• performed at one institution
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Huanlei Zhang and Ying Zou contributed equally as co-first authors.
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Zhang, H., Zou, Y., Tian, F. et al. Dual-energy CT may predict post-operative recurrence in early-stage glottic laryngeal cancer: a novel nomogram and risk stratification system. Eur Radiol 32, 1921–1930 (2022). https://doi.org/10.1007/s00330-021-08265-2
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DOI: https://doi.org/10.1007/s00330-021-08265-2