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Radiomics-based nomogram guides adaptive de-intensification in locoregionally advanced nasopharyngeal carcinoma following induction chemotherapy

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Abstract

Objectives

This study aimed to construct a radiomics-based model for prognosis and benefit prediction of concurrent chemoradiotherapy (CCRT) versus intensity-modulated radiotherapy (IMRT) in locoregionally advanced nasopharyngeal carcinoma (LANPC) following induction chemotherapy (IC).

Materials and methods

A cohort of 718 LANPC patients treated with IC + IMRT or IC + CCRT were retrospectively enrolled and assigned to a training set (n = 503) and a validation set (n = 215). Radiomic features were extracted from pre-IC and post-IC MRI. After feature selection, a delta-radiomics signature was built with LASSO-Cox regression. A nomogram incorporating independent clinical indicators and the delta-radiomics signature was then developed and evaluated for calibration and discrimination. Risk stratification by the nomogram was evaluated with Kaplan–Meier methods.

Results

The delta-radiomics signature, which comprised 19 selected features, was independently associated with prognosis. The nomogram, composed of the delta-radiomics signature, age, T category, N category, treatment, and pre-treatment EBV DNA, showed great calibration and discrimination with an area under the receiver operator characteristic curve of 0.80 (95% CI 0.75–0.85) and 0.75 (95% CI 0.64–0.85) in the training and validation sets. Risk stratification by the nomogram, excluding the treatment factor, resulted in two groups with distinct overall survival. Significantly better outcomes were observed in the high-risk patients with IC + CCRT compared to those with IC + IMRT, while comparable outcomes between IC + IMRT and IC + CCRT were shown for low-risk patients.

Conclusion

The radiomics-based nomogram can predict prognosis and survival benefits from concurrent chemotherapy for LANPC following IC. Low-risk patients determined by the nomogram may be potential candidates for omitting concurrent chemotherapy during IMRT.

Clinical relevance statement

The radiomics-based nomogram was constructed for risk stratification and patient selection. It can help guide clinical decision-making for patients with locoregionally advanced nasopharyngeal carcinoma following induction chemotherapy, and avoid unnecessary toxicity caused by overtreatment.

Key Points

• The benefits from concurrent chemotherapy remained controversial for locoregionally advanced nasopharyngeal carcinoma following induction chemotherapy.

• Radiomics-based nomogram achieved prognosis and benefits prediction of concurrent chemotherapy.

• Low-risk patients defined by the nomogram were candidates for de-intensification.

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Abbreviations

AJCC:

American Joint Committee on Cancer

AUC:

Area under the receiver operator characteristics curve

CCRT:

Concurrent chemoradiotherapy

CE-T1WI:

Contrast-enhanced T1-weighted images

CI:

Confidence interval

C-index:

Harrell’s concordance index

CR:

Complete response

DFS:

Disease-free survival

EBV:

Epstein–Barr virus

HR:

Hazard ratio

IC:

Induction chemotherapy

ICC:

Inter-class correlation coefficient

IMRT:

Intensity-modulated radiotherapy

LANPC:

Locoregional advanced nasopharyngeal carcinoma

LASSO:

Least absolute shrinkage and selection operator

MRI:

Magnetic resonance imaging

NPC:

Nasopharyngeal carcinoma

OS:

Overall survival

PACS:

Picture archiving and communication system

PCC:

Pearson correlation coefficient

PD:

Disease progression

PR:

Partial response

RECIST:

Response Evaluation Criteria in Solid Tumors

RF:

Radiomic feature

ROI:

Region of interest

SD:

Stable disease

T1WI:

T1-weighted images

T2WI:

T2-weighted images

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Funding

This study was supported by the National Natural Science Foundation of China (82272740); and the Sun Yat-Sen University Clinical Research 5010 Program (2020-FXY-406). The funding sources had no role in study design, data collection and analysis, manuscript preparation, or decision to publish.

Author information

Authors and Affiliations

  1. Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, 510060, China

    Shun-Xin Wang, Yi Yang, Xin Yang, Zhi-Qiao Liu, Yi-Ming Lei, Ying Sun, Jun Ma & Yan-Ping Mao

  2. Department of Radiology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, 510060, China

    Hui Xie, Hao-Jiang Li, Wen-Jie Huang & Li-Zhi Liu

  3. Department of Medical Oncology, The Seventh Affiliated Hospital of Sun Yat-Sen University, Shenzhen, China

    Wei-Jie Luo

  4. Department of Head and Neck Surgery, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, 510060, China

    Yan-Feng Chen

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  1. Shun-Xin Wang
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Corresponding authors

Correspondence to Yan-Feng Chen, Li-Zhi Liu or Yan-Ping Mao.

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Guarantor

The scientific guarantor of this publication is Yan-Ping Mao.

Conflict of interest

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.

Statistics and biometry

One of the authors (Shun-Xin Wang, Sun Yat-sen University Cancer Center) who has significant statistical expertise performed all statistical analyses. The key raw data underlying this study were uploaded to the Research Data Deposit public platform (RDDA2024775288). Reasonable requests for data sharing should be made to the corresponding author and will be handled in line with the data access and sharing policy of Human Genetic Resource Administration of China and other participating sites outside of China.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained. The institutional ethics committee of Sun Yat-sen University Cancer Center approved this study.

Study subjects or cohorts overlap

The whole study cohort has been reported in our previous study [Luo et al Radiother Oncol 2021], but the difference is that the current study applied radiomics to establish a predictive model and assist clinical decision-making for locoregionally advanced nasopharyngeal carcinoma following induction chemotherapy.

Methodology

• retrospective

• observational

• performed at one institution

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Shun-Xin Wang, Yi Yang, and Hui Xie should be considered joint first authors.

Yan-Ping Mao, Li-Zhi Liu, and Yan-Feng Chen should be considered joint senior authors and are co-corresponding authors.

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Wang, SX., Yang, Y., Xie, H. et al. Radiomics-based nomogram guides adaptive de-intensification in locoregionally advanced nasopharyngeal carcinoma following induction chemotherapy. Eur Radiol (2024). https://doi.org/10.1007/s00330-024-10678-8

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  • DOI: https://doi.org/10.1007/s00330-024-10678-8

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