Abstract
BACKGROUND: Neoadjuvant chemoimmunotherapy (NACI) regimen (camrelizumab plus paclitaxel and nedaplatin) has shown promising potential in patients with esophageal squamous cell carcinoma (ESCC), but accurately predicting the therapeutic response remains a challenge. OBJECTIVE: To develop and validate a CT-based machine learning model that incorporates both intratumoral and peritumoral heterogeneity for predicting the pathological response of ESCC patients after NACI. METHODS: Patients with ESCC who underwent surgery following NACI between June 2020 and July 2024 were included retrospectively and prospectively. Univariate and multivariate logistic regression analyses were performed to identify clinical variables associated with pathological response. Traditional radiomics features and habitat radiomics features from the intratumoral and peritumoral regions were extracted from posttreatment CT images, and 6 predictive models were established using 14 machine learning algorithms. The combined model was developed by integrating intratumoral and peritumoral habitat radiomics features with clinical variables. The performance of the models was evaluated using the area under the receiver operating characteristic curve (AUC). RESULTS: A total of 157 patients (mean [SD] age, 59.6 [6.5] years) were enrolled in our study, of whom 60 (38.2%) achieved major pathological response (MPR) and 40 (25.5%) achieved pathological complete response (pCR). The combined model demonstrated excellent predictive ability for MPR after NACI, with an AUC of 0.915 (95% CI: 0.844-0.981), accuracy of 0.872, sensitivity of 0.733, and specificity of 0.938 in the test set. In sensitivity analysis focusing on pCR, the combined model exhibited robust performance, with an AUC of 0.895 (95% CI: 0.782 - 0.980) in the test set. CONCLUSION: The combined model integrating intratumoral and peritumoral habitat radiomics features with clinical variables can accurately predict MPR in ESCC patients after NACI and shows promising potential in predicting pCR.