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Radiomics nomogram outperforms size criteria in discriminating lymph node metastasis in resectable esophageal squamous cell carcinoma

  • Gastrointestinal
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

To determine the value of radiomics in predicting lymph node (LN) metastasis in resectable esophageal squamous cell carcinoma (ESCC) patients.

Methods

Data of 230 consecutive patients were retrospectively analyzed (154 in the training set and 76 in the test set). A total of 1576 radiomics features were extracted from arterial-phase CT images of the whole primary tumor. LASSO logistic regression was performed to choose the key features and construct a radiomics signature. A radiomics nomogram incorporating this signature was developed on the basis of multivariable analysis in the training set. Nomogram performance was determined and validated with respect to its discrimination, calibration and reclassification. Clinical usefulness was estimated by decision curve analysis.

Results

The radiomics signature including five features was significantly associated with LN metastasis. The radiomics nomogram, which incorporated the signature and CT-reported LN status (i.e. size criteria), distinguished LN metastasis with an area under curve (AUC) of 0.758 in the training set, and performance was similar in the test set (AUC 0.773). Discrimination of the radiomics nomogram exceeded that of size criteria alone in both the training set (p <0.001) and the test set (p=0.005). Integrated discrimination improvement (IDI) and categorical net reclassification improvement (NRI) showed significant improvement in prognostic value when the radiomics signature was added to size criteria in the test set (IDI 17.3%; p<0.001; categorical NRI 52.3%; p<0.001). Decision curve analysis supported that the radiomics nomogram is superior to size criteria.

Conclusions

The radiomics nomogram provides individualized risk estimation of LN metastasis in ESCC patients and outperforms size criteria.

Key Points

• A radiomics nomogram was built and validated to predict LN metastasis in resectable ESCC.

• The radiomics nomogram outperformed size criteria.

• Radiomics helps to unravel intratumor heterogeneity and can serve as a novel biomarker for determination of LN status in resectable ESCC.

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Abbreviations

AJCC:

American Joint Committee on Cancer

AUC:

Area under curve

CT:

Computed tomography

ESCC:

Esophageal squamous cell carcinoma

GLCM:

Gray level co-occurrence matrix

GLRLM:

Gray level run length matrix

GLSZM:

Gray level size zone matrix

ICC:

Intra-class correlation coefficient

IDI:

Integrated discrimination improvement

LASSO:

Least absolute shrinkage and selection operator

LN:

Lymph node

NLR:

Neutrophil-to-lymphocyte ratio

NRI:

Net reclassification improvement

PLR:

Platelet-to-lymphocyte ratio

ROC:

Receiver operator characteristic

VOI:

Volume of interest

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Funding

This study has received funding by the National Key Research and Development Plan of China (grant number: 2017YFC1309100), National Natural Scientific Foundation of China (grant number: 81771912 and U1301258) and Science and Technology Planning Project of Guangdong Province (grant number: 2017B020227012)

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Authors and Affiliations

  1. The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, People’s Republic of China

    Xianzheng Tan, Lifen Yan, Zaiyi Liu & Changhong Liang

  2. Department of Radiology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, 510080, Guangdong, People’s Republic of China

    Xianzheng Tan, Lifen Yan, Weitao Ye, Zaiyi Liu & Changhong Liang

  3. Department of Radiology, Hunan Provincial People’s Hospital, Changsha, 410005, Hunan Province, People’s Republic of China

    Xianzheng Tan

  4. Guangdong Provincial Traditional Chinese Medicine Hospital, Guangzhou, Guangdong Province, 510120, People’s Republic of China

    Zelan Ma

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  1. Xianzheng Tan
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Correspondence to Zaiyi Liu or Changhong Liang.

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The scientific guarantor of this publication is Changhong Liang.

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

No complex statistical methods were necessary for this paper.

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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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Tan, X., Ma, Z., Yan, L. et al. Radiomics nomogram outperforms size criteria in discriminating lymph node metastasis in resectable esophageal squamous cell carcinoma. Eur Radiol 29, 392–400 (2019). https://doi.org/10.1007/s00330-018-5581-1

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  • DOI: https://doi.org/10.1007/s00330-018-5581-1

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