Abstract
BACKGROUND: Accurate pretherapeutic prognostication is important for tailoring treatment in cervical cancer (CC). PURPOSE: To investigate whether pretreatment MRI-based radiomic signatures predict disease-specific survival (DSS) in CC. STUDY TYPE: Retrospective. POPULATION: CC patients (n = 133) allocated into training((T)) (n(T) = 89)/validation((V)) (n(V) = 44) cohorts. FIELD STRENGTH/SEQUENCE: T2-weighted imaging (T2WI) and diffusion-weighted imaging (DWI) at 1.5T or 3.0T. ASSESSMENT: Radiomic features from segmented tumors were extracted from T2WI and DWI (high b-value DWI and apparent diffusion coefficient (ADC) maps). STATISTICAL TESTS: Radiomic signatures for prediction of DSS from T2WI (T2(rad) ) and T2WI with DWI (T2 + DWI(rad) ) were constructed by least absolute shrinkage and selection operator (LASSO) Cox regression. Area under time-dependent receiver operating characteristics curves (AUC) were used to evaluate and compare the prognostic performance of the radiomic signatures, MRI-derived maximum tumor size ≤/> 4 cm (MAX(size) ), and 2018 International Federation of Gynecology and Obstetrics (FIGO) stage (I-II/III-IV). Survival was analyzed using Cox model estimating hazard ratios (HR) and Kaplan-Meier method with log-rank tests. RESULTS: The radiomic signatures T2(rad) and T2 + DWI(rad) yielded AUC(T) /AUC(V) of 0.80/0.62 and 0.81/0.75, respectively, for predicting 5-year DSS. Both signatures yielded better or equal prognostic performance to that of MAX(size) (AUC(T) /AUC(V) : 0.69/0.65) and FIGO (AUC(T) /AUC(V) : 0.77/0.64) and were significant predictors of DSS after adjusting for FIGO (HR(T) /HR(V) for T2(rad) : 4.0/2.5 and T2 + DWI(rad) : 4.8/2.1). Adding T2(rad) and T2 + DWI(rad) to FIGO significantly improved DSS prediction compared to FIGO alone in cohort((T)) (AUC(T) 0.86 and 0.88 vs. 0.77), and FIGO with T2 + DWI(rad) tended to the same in cohort((V)) (AUC(V) 0.75 vs. 0.64, p = 0.07). High radiomic score for T2 + DWI(rad) was significantly associated with reduced DSS in both cohorts. DATA CONCLUSION: Radiomic signatures from T2WI and T2WI with DWI may provide added value for pretreatment risk assessment and for guiding tailored treatment strategies in CC.