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Dual-energy CT may predict post-operative recurrence in early-stage glottic laryngeal cancer: a novel nomogram and risk stratification system

  • Head and Neck
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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.

Funding

The authors state that this work has not received any funding.

Author information

Authors and Affiliations

  1. Department of Radiology, First Central Clinical College, Tianjin Medical University, No. 24 Fu Kang Road, Nankai District, Tianjin, 300192, China

    Huanlei Zhang, Shuangyan Sun, Fang Sun & Lianfang Shen

  2. Department of Radiology, Yidu Central Hospital of Weifang, No. 4138 Linglongshan South Road, Qingzhou City, 262500, Shandong, China

    Huanlei Zhang & Lianfang Shen

  3. Department of Radiology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, No. 314 Anshan West Road, Nankai District, Tianjin, 300193, China

    Ying Zou

  4. Department of Radiology, Affiliated Hospital of Nankai University (Tianjin No. 4 Hospital), Tianjin, 300222, China

    Fengyue Tian

  5. Department of Radiology, The First Hospital of Qinhuangdao, No. 258 Wenhua Road, Haigang District, Qinhuangdao, 066000, China

    Wenfei Li

  6. Department of Radiology, Tianjin First Central Hospital, School of Medicine, Nankai University, No. 24 Fu Kang Road, Nankai District, Tianjin, 300192, China

    Xiaodong Ji, Yu Guo, Qing Li & Shuang Xia

  7. Department of Radiology, Jilin Cancer Hospital, No. 1066 JinHu Road, Chaoyang District, , Changchun, 130000, China

    Shuangyan Sun

  8. Department of Ultrasonography, Binzhou Medical University Hospital, No. 661 Huanghe 2nd Road, Binzhou City, Shandong, 256603, China

    Fang Sun

Authors
  1. Huanlei Zhang
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  9. Fang Sun
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  10. Lianfang Shen
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  11. Shuang Xia
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Corresponding author

Correspondence to Shuang Xia.

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Guarantor

The scientific guarantor of this publication is Shuang Xia.

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

Fengyue Tian and Wenfei Li kindly provided statistical advice for this manuscript.

Informed consent

Written informed consent was waived by the Institutional Review Board.

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Institutional Review Board approval was obtained.

Methodology

  • • retrospective

  • • diagnostic or prognostic study

  • • performed at one institution

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Huanlei Zhang and Ying Zou contributed equally as co-first authors.

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Cite this article

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

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