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MRI radiomics signature to predict lymph node metastasis after neoadjuvant chemoradiation therapy in locally advanced rectal cancer

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Abstract

Purpose

To investigative the performance of MRI-radiomics analysis derived from T2WI and apparent diffusion coefficients (ADC) images before and after neoadjuvant chemoradiation therapy (nCRT) separately or simultaneously for predicting post-nCRT lymph node status in patients with locally advanced rectal cancer (LARC).

Materials and Methods

Eighty-three patients (training cohort, n = 57; validation cohort, n = 26) with LARC between June 2017 and December 2022 were retrospectively enrolled. All the radiomics features were extracted from volume of interest on T2WI and ADC images from baseline and post-nCRT MRI. Delta-radiomics features were defined as the difference between radiomics features before and after nCRT. Seven clinical-radiomics models were constructed by combining the most predictive radiomics signatures and clinical parameters selected from support vector machine. Receiver operating characteristic curve (ROC) was used to evaluate the performance of models. The optimum model-based LNM was applied to assess 5-years disease-free survival (DFS) using Kaplan–Meier analysis. The end point was clinical or radiological locoregional recurrence or distant metastasis during postoperative follow-up.

Results

Clinical-deltaADC radiomics combined model presented good performance for predicting post-CRT LNM in the training (AUC = 0.895,95%CI:0.838–0.953) and validation cohort (AUC = 0.900,95%CI:0.771–1.000). Clinical-deltaADC radiomics-postT2WI radiomics combined model also showed good performances (AUC = 0.913,95%CI:0.838–0.953) in the training and (AUC = 0.912,95%CI:0.771–1.000) validation cohort. As for subgroup analysis, clinical-deltaADC radiomics combined model showed good performance predicting LNM in ypT0-T2 (AUC = 0.827;95%CI:0.649–1.000) and ypT3-T4 stage (AUC = 0.934;95%CI:0.864–1.000). In ypT0-T2 stage, clinical-deltaADC radiomics combined model-based LNM could assess 5-years DFS (P = 0.030).

Conclusion

Clinical-deltaADC radiomics combined model could predict post-nCRT LNM, and this combined model-based LNM was associated with 5-years DFS in ypT0-T2 stage.

Graphical Abstract

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Data availability

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Abbreviations

nCRT:

Neoadjuvant chemoradiation therapy

LARC:

Locally advanced rectal cancer

LN:

Lymph node

LNM:

Lymph node metastases

ADC:

Apparent diffusion coefficient

DWI:

Diffusion weighted imaging

AUC:

Areas under the receiver operating characteristic curve

ROC:

Receiver operating characteristic

EMVI:

Extramural vascular invasion

MRF:

Mesorectal fascia

CI:

Confidence interval

CEA:

Carcinoembryonic antigen

CA199:

Carbohydrate antigen 199

IDBMP:

Invasion distance beyond the muscularis propria

SDMPT:

Shortest distance between the mesorectal fascia and the outer edge of the tumor extension

SVM:

Support vector machine

RBF:

Radial basis function

ROIs:

Regions of interest

ICC:

Intraclass correlation coefficient

DCA:

Decision curve analysis

NRI:

Continuous net reclassification improvement

IDI:

Integrated discrimination improvement

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Acknowledgements

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Funding

This work was supported by Sichuan Science and Technology Program (Grant No. 23ZDYF1685) and the Key Research Project of Sichuan Province (Grant No. 2022YFS0249).

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Author notes

  1. Hang Li and Hong Pu have contributed equally to this work.

Authors and Affiliations

  1. Department of Radiology, Sichuan Academy of Medical Sciences and Sichuan Provincial People’s Hospital, 32# Second Section of First Ring Road, Qingyang District, Chengdu, 610070, Sichuan, China

    Zhu Fang, Hong Pu, Yi Yuan, Feng Zhang & Hang Li

  2. Department of Radiology, Affiliated Cancer Hospital of Medical School, University of Electronic Science and Technology of China, Sichuan Cancer Hospital, 55#Four Section of South Renmin Road, Wuhou District, Chengdu, 610000, China

    Xiao-li Chen

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  1. Zhu Fang
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Correspondence to Hang Li.

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Fang, Z., Pu, H., Chen, Xl. et al. MRI radiomics signature to predict lymph node metastasis after neoadjuvant chemoradiation therapy in locally advanced rectal cancer. Abdom Radiol 48, 2270–2283 (2023). https://doi.org/10.1007/s00261-023-03910-4

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