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- Document type:
- Journal Article; Multicenter Study
- Author(s):
- Healy, Gerard M; Salinas-Miranda, Emmanuel; Jain, Rahi; Dong, Xin; Deniffel, Dominik; Borgida, Ayelet; Hosni, Ali; Ryan, David T; Njeze, Nwabundo; McGuire, Anne; Conlon, Kevin C; Dodd, Jonathan D; Ryan, Edmund Ronan; Grant, Robert C; Gallinger, Steven; Haider, Masoom A
- Title:
- Pre-operative radiomics model for prognostication in resectable pancreatic adenocarcinoma with external validation.
- Abstract:
- OBJECTIVES: In resectable pancreatic ductal adenocarcinoma (PDAC), few pre-operative prognostic biomarkers are available. Radiomics has demonstrated potential but lacks external validation. We aimed to develop and externally validate a pre-operative clinical-radiomic prognostic model. METHODS: Retrospective international, multi-center study in resectable PDAC. The training cohort included 352 patients (pre-operative CTs from five Canadian hospitals). Cox models incorporated (a) pre-operative clinical variables (clinical), (b) clinical plus CT-radiomics, and (c) post-operative TNM model, which served as the reference. Outcomes were overall (OS)/disease-free survival (DFS). Models were assessed in the validation cohort from Ireland (n = 215, CTs from 34 hospitals), using C-statistic, calibration, and decision curve analyses. RESULTS: The radiomic signature was predictive of OS/DFS in the validation cohort, with adjusted hazard ratios (HR) 2.87 (95% CI: 1.40-5.87, p < 0.001)/5.28 (95% CI 2.35-11.86, p < 0.001), respectively, along with age 1.02 (1.01-1.04, p = 0.01)/1.02 (1.00-1.04, p = 0.03). In the validation cohort, median OS was 22.9/37 months (p = 0.0092) and DFS 14.2/29.8 (p = 0.0023) for high-/low-risk groups and calibration was moderate (mean absolute errors 7%/13% for OS at 3/5 years). The clinical-radiomic model discrimination (C = 0.545, 95%: 0.543-0.546) was higher than the clinical model alone (C = 0.497, 95% CI 0.496-0.499, p < 0.001) or TNM (C = 0.525, 95% CI: 0.524-0.526, p < 0.001). Despite superior net benefit compared to the clinical model, the clinical-radiomic model was not clinically useful for most threshold probabilities. CONCLUSION: A multi-institutional pre-operative clinical-radiomic model for resectable PDAC prognostication demonstrated superior net benefit compared to a clinical model but limited clinical utility at external validation. This reflects inherent limitations of radiomics for PDAC prognostication, when deployed in real-world settings. KEY POINTS: • At external validation, a pre-operative clinical-radiomics prognostic model for pancreatic ductal adenocarcinoma (PDAC) outperformed pre-operative clinical variables alone or pathological TNM staging. • Discrimination and clinical utility of the clinical-radiomic model for treatment decisions remained low, likely due to heterogeneity of CT acquisition parameters. • Despite small improvements, prognosis in PDAC using state-of-the-art radiomics methodology remains challenging, mostly owing to its low discriminative ability. Future research should focus on standardization of CT protocols and acquisition parameters.
- Journal title abbreviation:
- Eur Radiol
- Year:
- 2022
- Journal volume:
- 32
- Journal issue:
- 4
- Pages contribution:
- 2492-2505
- Fulltext / DOI:
- doi:10.1007/s00330-021-08314-w
- Pubmed ID:
- http://view.ncbi.nlm.nih.gov/pubmed/34757450
- Print-ISSN:
- 0938-7994
- TUM Institution:
- Institut für Diagnostische und Interventionelle Radiologie
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