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Delta computed tomography radiomics features-based nomogram predicts long-term efficacy after neoadjuvant chemotherapy in advanced gastric cancer

  • Abdominal Radiology
  • Published:
La radiologia medica Aims and scope Submit manuscript

Abstract

Background and objective

No effective preoperative tool is available for predicting the prognosis of advanced gastric cancer (AGC) treated by neoadjuvant chemotherapy (NAC). We aimed to explore the association between change values (“delta”) in the radiomic signatures of computed tomography (CT) (delCT-RS) before and after NAC for AGC and overall survival(OS).

Methods and design

A total of 132 AGC patients with AGC were studied as a training cohort in our center, and 45 patients from another center were used as an external validation set. A radiomic signatures-clinical-nomogram(RS-CN) was established using delCT-RS and preoperative clinical variables. The prediction performance of RS-CN was evaluated using the area under the receiver operating characteristic (ROC)curve (AUC values), time-dependent ROC, decision curve analysis(DCA) and C-index.

Results

Multivariable Cox regression analyses showed that delCT-RS, cT-stage, cN-stage, Lauren-type and the value of variation of carcinoma embryonic antigen (CEA) between NAC were independent risk factors for 3-year OS of AGC. In the training cohort, RS-CN had a good prediction performance for OS (C-Index 0.73) and AUC values were significantly better than those of delCT-RS, ypTNM-stage and tumor regression grade(TRG) (0.827 vs 0.704 vs 0.749 vs 0.571, p < 0.001). DCA and time-dependent ROC of RS-CN were better than those of ypTNM stage, TRG grade and delCT-RS. The prediction performance of the validation set was equivalent to that of the training set. The cut-off (177.2) of RS-CN score was obtained from X-Tile software, a score of > 177.2 was defined as high-risk group(HRG), and scores of ≤ 177.2 were defined as the low-risk group(LRG). The 3-year OS and disease free survival(DFS) of patients in the LRG were significantly better than those in the HRG. Adjuvant chemotherapy(AC) can only significantly improve the 3-year OS and DFS of the LRG. (p < 0.05).

Conclusions

Our nomogram based on delCT-RS has good prediction of prognosis before surgery and helps identify patients that are most likely to benefit from AC. It works well in precise and individualised NAC in AGC.

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Availability of data and materials

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

AGC:

Advanced gastric cancer

cT-stage:

Clinical T stage according to American Joint Committee on Cancer (AJCC) staging system for gastric Cancer (AJCC 8th)

cN-stage:

Clinical N stage according to American Joint Committee on Cancer (AJCC) staging system for gastric Cancer (AJCC 8th)

OS:

Overall Survival

DFS:

Disease free survival

CEA:

Carcinoma embryonic antigen

NAC:

Neoadjuvant chemotherapy

AC:

Adjuvant chemotherapy

YpT:

Tumor (T pathological stage) after neoadjuvant chemotherapy

YpN:

Nodes pathological stage after neoadjuvant chemotherapy.

BMI:

Body Mass Index

ECOG:

Eastern Cooperative Oncology Group

LN:

Lymph node

RECIST:

Response evaluation criteria in solid tumors

AUC:

Area under the curve

ROC:

Receiver operating characteristic

TRG:

Tumor regression grade

Time-dependent ROC:

Incorporated time dependency of area under the curve of ROC

DCA:

Decision curve analysis

ICC:

Intraclass correlation coefficient

CT:

Computed tomography

ROI:

Region of interest

GLCM:

Gray-level co-occurrence matrix

GLDM:

Gray-level dependence matrix

GLSZM:

Gray-level size zone matrix

GLRLM:

Gray-level run length matrix

CT-RS:

CT-based radiomics features scores

RS-CN:

Radiomic signatures-clinical-nomogram

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Funding

Fujian Key Minimally Invasive Medical Center NO. [2021] 662.

Author information

Author notes

  1. Li-Li Shen and Hua-Long Zheng have contributed equally to this work.

  2. Co First author: Li-Li Shen and Hua-Long Zheng.

Authors and Affiliations

  1. Department of Gastric Surgery, Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian, China

    Li-Li Shen, Hua-Long Zheng, Jun Lu, Qi-Yue Chen, Bin-bin Xu, Zheng Xue, Jia Lin, Chang-Ming Huang & Chao-Hui Zheng

  2. Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China

    Li-Li Shen, Hua-Long Zheng, Jun Lu, Qi-Yue Chen, Bin-bin Xu, Zheng Xue, Jia Lin, Chang-Ming Huang & Chao-Hui Zheng

  3. Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China

    Li-Li Shen, Hua-Long Zheng, Jun Lu, Qi-Yue Chen, Bin-bin Xu, Zheng Xue, Jia Lin, Chang-Ming Huang & Chao-Hui Zheng

  4. Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China

    Li-Li Shen, Hua-Long Zheng, Jun Lu, Qi-Yue Chen, Bin-bin Xu, Zheng Xue, Jia Lin, Chang-Ming Huang & Chao-Hui Zheng

  5. Department of General Surgery, The First Hospital of Lanzhou University, Donggang, China

    Fang-Hui Ding

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Contributions

Drs Shen LL and Zheng HL contributed equally to this work and should be considered first coauthors. Dr. Zheng CH had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Corresponding author

Correspondence to Chao-Hui Zheng.

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All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions. Informed consent or substitute for it was obtained from all patients for being included in the study.

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Shen, LL., Zheng, HL., Ding, FH. et al. Delta computed tomography radiomics features-based nomogram predicts long-term efficacy after neoadjuvant chemotherapy in advanced gastric cancer. Radiol med 128, 402–414 (2023). https://doi.org/10.1007/s11547-023-01617-6

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