Development of a radiomics nomogram to predict the treatment resistance of Chinese MPO-AAV patients with lung involvement: a two-center study

Juan Chen; Ting Meng; Jia Xu; Joshua D Ooi; Peter J Eggenhuizen; Wenguang Liu; Fang Li; Xueqin Wu; Jian Sun; Hao Zhang; Ya-Ou Zhou; Hui Luo; Xiangcheng Xiao; Yigang Pei; Wenzheng Li; Yong Zhong

doi:10.3389/fimmu.2023.1084299

Development of a radiomics nomogram to predict the treatment resistance of Chinese MPO-AAV patients with lung involvement: a two-center study

Front Immunol. 2023 Jul 12:14:1084299. doi: 10.3389/fimmu.2023.1084299. eCollection 2023.

Authors

Juan Chen^{1

2}, Ting Meng³, Jia Xu³, Joshua D Ooi^{3

4}, Peter J Eggenhuizen⁴, Wenguang Liu^{1

2}, Fang Li^{1

2}, Xueqin Wu⁵, Jian Sun⁵, Hao Zhang⁵, Ya-Ou Zhou⁶, Hui Luo⁶, Xiangcheng Xiao³, Yigang Pei^{1

2}, Wenzheng Li^{1

2}, Yong Zhong^{3

7}

Affiliations

¹ Department of Radiology, Xiangya Hospital, Central South University, Changsha, Hunan, China.
² National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China.
³ Department of Nephrology, Xiangya Hospital, Central South University, Changsha, Hunan, China.
⁴ Centre for Inflammatory Diseases, Monash University, Clayton, VIC, Australia.
⁵ Department of Nephrology, The third Xiangya Hospital, Central South University, Changsha, Hunan, China.
⁶ Department of Rheumatology and Immunology, Xiangya Hospital, Central South University, Changsha, China.
⁷ Key Laboratory of Biological Nanotechnology of National Health Commission, Xiangya Hospital, Central South University, Changsha, Hunan, China.

Abstract

Background: Previous studies from our group and other investigators have shown that lung involvement is one of the independent predictors for treatment resistance in patients with myeloperoxidase (MPO)-anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (MPO-AAV). However, it is unclear which image features of lung involvement can predict the therapeutic response in MPO-AAV patients, which is vital in decision-making for these patients. Our aim was to develop and validate a radiomics nomogram to predict treatment resistance of Chinese MPO-AAV patients based on low-dose multiple slices computed tomography (MSCT) of the involved lung with cohorts from two centers.

Methods: A total of 151 MPO-AAV patients with lung involvement (MPO-AAV-LI) from two centers were enrolled. Two different models (Model 1: radiomics signature; Model 2: radiomics nomogram) were built based on the clinical and MSCT data to predict the treatment resistance of MPO-AAV with lung involvement in training and test cohorts. The performance of the models was assessed using the area under the curve (AUC). The better model was further validated. A nomogram was constructed and evaluated by DCA and calibration curves, which further tested in all enrolled data and compared with the other model.

Results: Model 2 had a higher predicting ability than Model 1 both in training (AUC: 0.948 vs. 0.824; p = 0.039) and test cohorts (AUC: 0.913 vs. 0.898; p = 0.043). As a better model, Model 2 obtained an excellent predictive performance (AUC: 0.929; 95% CI: 0.827-1.000) in the validation cohort. The DCA curve demonstrated that Model 2 was clinically feasible. The calibration curves of Model 2 closely aligned with the true treatment resistance rate in the training (p = 0.28) and test sets (p = 0.70). In addition, the predictive performance of Model 2 (AUC: 0.929; 95% CI: 0.875-0.964) was superior to Model 1 (AUC: 0.862; 95% CI: 0.796-0.913) and serum creatinine (AUC: 0.867; 95% CI: 0.802-0.917) in all patients (all p< 0.05).

Conclusion: The radiomics nomogram (Model 2) is a useful, non-invasive tool for predicting the treatment resistance of MPO-AAV patients with lung involvement, which might aid in individualizing treatment decisions.

Keywords: ANCA-associated vasculitis; lung involvement; myeloperoxidase; radiomics nomogram; treatment resistance.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis*
Antibodies, Antineutrophil Cytoplasmic
East Asian People*
Humans
Lung Diseases / diagnostic imaging
Nomograms
Peroxidase

Substances

Antibodies, Antineutrophil Cytoplasmic
Peroxidase

Grants and funding

This work was funded by the National Key R&D Program of China (2020YFC2005000 to XX), the Key Research and Development Program of Hunan province (2020WK2008 to YZ), the Science and Technology Innovation Program of Hunan Province (2020RC5002 to JO), the Natural Science Foundation of Hunan Province (2021JJ31130 to YZ), the Project of Health Commission of Hunan Province (A202303050036 to YZ), “Yiluqihang Shenmingyuanyang” Medical Development and Scientific Research Fund Project on Kidney Diseases (SMYY20220301001 to YZ), the National Natural Science Foundation of China (82071895 to WZL), and China Postdoctoral Science Foundation (2019M652807 to YP).