Background and purpose: We aimed to develop a radiomics model for the prediction of survival and chemotherapeutic benefits using pretreatment multiparameter MR images and clinicopathological features in patients with locally advanced rectal cancer (LARC).
Materials and methods: 186 consecutive patients with LARC underwent feature extraction from the whole tumor on T2-weighted, contrast enhanced T1-weighted, and ADC images. Feature selection was based on feature stability and the Boruta algorithm. Radiomics signatures for predicting DFS (disease-free survival) were then generated using the selected features. Combining clinical risk factors, a radiomics nomogram was constructed using Cox proportional hazards regression model. The predictive performance was evaluated by Harrell's concordance indices (C-index) and time-independent receiver operating characteristic (ROC) analysis.
Results: Four features were selected to construct the radiomics signature, significantly associated with DFS (P < 0.001). The radiomics nomogram, incorporating radiomics signature and two clinicopathological variables (pN and tumor differentiation), exhibited better prediction performance for DFS than the clinicopathological model, with C-index of 0.780 (95%CI, 0.718-0.843) and 0.803 (95%CI, 0.717-0.889) in the training and validation cohorts, respectively. The radiomics nomogram-defined high-risk group had a shorter DFS, DMFS, and OS than those in the low-risk group (all P < 0.05). Further analysis showed that patients with higher nomogram-defined score exhibited a favorable response to adjuvant chemotherapy (AC) while the low-risk could not.
Conclusion: This study demonstrated that the newly developed pretreatment multiparameter MRI-based radiomics model could serve as a powerful predictor of prognosis, and may act as a potential indicator for guiding AC in patients with LARC.
Keywords: Disease-free survival; Locally advanced rectal cancer; Magnetic resonance imaging; Radiomics.
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