Abstract
INTRODUCTION: To study the relationship between the tumor heterogeneity based on CT and overall survival (OS) in oesophageal squamous cell carcinoma treated with chemotherapy and radiation therapy (CRT). METHODS: Fifty-seventh clinical patients who underwent definitive CRT were analyzed. The results were analyzed in terms of whole-tumor texture, with quantification of entropy, mean gray-level intensity for fine to coarse textures (filters 1.0-2.5, respectively). The association between texture parameters and survival time was assessed by Kaplan-Meier analysis and a Cox proportional hazards model. RESULTS: The median, 1 and 3 years OS, were 20.2 months, 75.4%, and 32.1%. In the univariate analysis performed using the log-rank test found global entropies (P= 0.0119), global mean (P= 0.088), global Std (P= 0.0209), and global uniformity (P= 0.0284) were found to be significant OS prognostic factors for filter value 1.0. Cox proportional hazards models that included a combination of pretreatment GlobalStd and post-treatment volume yields the best performance in predicting OS. Kaplan-Meier curves show that the patients in the high-risk group have significantly worse OS (log-rank test, P= 0.0009) and progression-free survival (PFS) (log-rank test, P= 0.0019) than those in the low-risk group. CONCLUSION: Pretreatment texture parameters are associated with survival time, and the combination of post volume performed better in survival models.