Pre-operative radiomics model for prognostication in resectable pancreatic adenocarcinoma with external validation

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..

Medienart:	Artikel

Erscheinungsjahr:	2021
Erschienen:	2021

Enthalten in:	Zur Gesamtaufnahme - volume:32
Enthalten in:	European radiology - 32(2021), 4 vom: 10. Nov., Seite 2492-2505

Sprache:	Englisch

Beteiligte Personen:

Healy, Gerard M. [VerfasserIn] Salinas-Miranda, Emmanuel [VerfasserIn] Jain, Rahi [VerfasserIn] Dong, Xin [VerfasserIn] Deniffel, Dominik [VerfasserIn] Borgida, Ayelet [VerfasserIn] Hosni, Ali [VerfasserIn] Ryan, David T. [VerfasserIn] Njeze, Nwabundo [VerfasserIn] McGuire, Anne [VerfasserIn] Conlon, Kevin C. [VerfasserIn] Dodd, Jonathan D. [VerfasserIn] Ryan, Edmund Ronan [VerfasserIn] Grant, Robert C. [VerfasserIn] Gallinger, Steven [VerfasserIn] Haider, Masoom A. [VerfasserIn]

Links:	Volltext [lizenzpflichtig]

Themen:	External validation Pancreatic adenocarcinoma Pre-operative Radiomics Survival

Anmerkungen:	© European Society of Radiology 2021

doi:	10.1007/s00330-021-08314-w

funding:
Förderinstitution / Projekttitel:

PPN (Katalog-ID):	OLC2078243434