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Prognostic impact of semantic MRI features on survival outcomes in molecularly subtyped medulloblastoma

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Abstract

Purpose

Imaging features are known to reflect inherent disease biology in various cancers including brain tumors. We report on the prognostic impact of magnetic resonance imaging (MRI) features on survival in patients with medulloblastoma treated between 2007 and 2018 at our institute.

Methods

Sixteen semantic imaging features (with predefined categories) were extracted from pre- and postcontrast T1-weighted and T2-weighted MRI by consensus. Univariate analysis and multivariate Cox regression analysis were performed to assess the correlation of semantic features with relapse-free survival (RFS) and overall survival (OS).

Results

The study cohort comprised 171 medulloblastoma patients (median age 9 years) treated with maximal safe resection followed by risk-stratified adjuvant radio(chemo)therapy. A total of 55 patients experienced recurrent/progressive disease (commonly neuraxial metastases) resulting in 44 deaths, including one treatment-related death. At a median follow-up of 45 months (interquartile range 19–65 months), 5‑year Kaplan–Meier estimates of RFS and OS were 64% and 71%, respectively. Semantic MRI features such as non-central tumor location on vertical axis, absence of brainstem involvement, ≤ 80% solid tumor area with contrast uptake, heterogenous pattern of contrast enhancement, necrosis, calcification, and T2-weighted heterogeneity were associated with significantly worse RFS and/or OS in univariate analysis. Cox regression analysis identified tumor location on the vertical axis, brainstem involvement, and calcification as independent prognostic factors impacting outcomes. Distinctive MRI features correlated with survival even within individual molecular subgroups of medulloblastoma.

Conclusion

Distinctive semantic MRI features correlate significantly with survival outcomes in medulloblastoma, also within individual molecular subgroups, reflecting their prognostic impact.

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Acknowledgements

We acknowledge and thank Nazia Bano, Shraddha Churi, and Farnaz Shaikh for their logistic and secretarial assistance during the conduct of the study. We express our gratitude to all patients and their caregivers who participated in the study.

Funding

(i) Intramural grant from Tata Memorial Centre, Mumbai; (ii) Indian Council of Medical Research (ICMR), New Delhi; and (iii) Brain Tumor Foundation (BTF) of India, Mumbai. The funding bodies had no influence on study design, data collection, analysis, interpretation of data, or the manuscript’s writing.

Author information

Authors and Affiliations

  1. Department of Radiation Oncology, ACTREC/TMH Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Kharghar, 410210, Navi Mumbai, India

    Archya Dasgupta MD,  Tejpal Gupta MD, Madan Maitre MD, Babusha Kalra MD, Abhishek Chatterjee MD, Rahul Krishnatry MD, Jayant Sastri Goda MD & Rakesh Jalali MD

  2. Neuro-oncology Lab, ACTREC/TMH, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India

    Neelam Shirsat PhD

  3. Department of Pathology, ACTREC/TMH, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India

    Sridhar Epari MD & Ayushi Sahay MD

  4. Department of Radio-diagnosis, ACTREC/TMH, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India

    Amit Janu DNB

  5. Department of Radio-diagnosis and Imaging, Global Hospitals, Mumbai, India

    Sona Pungavkar DNB

  6. Department of Pediatric Oncology, ACTREC/TMH, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India

    Girish Chinnaswamy DM

  7. Department of Medical Oncology, ACTREC/TMH, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India

    Vijay Patil DM

  8. Department of Neurosurgery, ACTREC/TMH, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India

    Aliasgar Moiyadi MCh & Prakash Shetty MCh

Authors
  1. Archya Dasgupta MD
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  2. Tejpal Gupta MD
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  17. Rakesh Jalali MD
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Contributions

Conception and design: T. Gupta and R. Jalali conceptualized the study, and A. Dasgupta wrote the study protocol; collection and assembly of data: all authors; data analysis and interpretation: A. Dasgupta, M. Maitre, B. Kalra, and T. Gupta; manuscript writing: A. Dasgupta prepared the initial draft, T. Gupta edited the final draft manuscript; final approval of manuscript: all authors. All the authors are in agreement and accountable for all aspects of the work.

Corresponding author

Correspondence to Tejpal Gupta MD.

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Conflict of interest

A. Dasgupta, T. Gupta, M. Maitre, B. Kalra, A. Chatterjee, R. Krishnatry, J. Sastri Goda, N. Shirsat, S. Epari, A. Sahay, A. Janu, S. Pungavkar, G. Chinnaswamy, V. Patil, A. Moiyadi, P. Shetty, and R. Jalali declare that they have no competing interests.

Additional information

Presentation

Presented in part at the 12th Virtual Annual Conference of the Indian Society of Neuro-Oncology (ISNOCON-2021) hosted by Christian Medical College, Vellore, India, in April 2021.

Availability of data and material

Data will be made available on request to the corresponding author following institutional ethics committee protocols.

Supplementary Information

Supplementary Table 1: Imaging feature extraction and characterization using conventional MRI

Supplementary Table 2: Distribution of MRI features across various molecular subgroups

Supplementary Table 3: Site of first relapse across the molecular subgroups

Figure S4: Kaplan–Meier curves of relapse-free survival (a) and overall survival (b) for the entire study cohort

66_2021_1889_MOESM5_ESM.tif

Figure S5: Kaplan–Meier curves of relapse-free survival (a) and overall survival (b) stratified by molecular subgrouping in medulloblastoma

66_2021_1889_MOESM6_ESM.tif

Figure S6: Kaplan–Meier curves demonstrating the prognostic impact of semantic MRI features—tumor location on the vertical axis (a), brainstem involvement (b), proportion of solid tumor with contrast uptake (c), pattern of contrast enhancement (d), necrosis (e), and calcification (f) on relapse-free survival in medulloblastoma

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Dasgupta, A., Gupta, T., Maitre, M. et al. Prognostic impact of semantic MRI features on survival outcomes in molecularly subtyped medulloblastoma. Strahlenther Onkol 198, 291–303 (2022). https://doi.org/10.1007/s00066-021-01889-9

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  • DOI: https://doi.org/10.1007/s00066-021-01889-9

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