Radiomics may increase the prognostic value for survival in glioblastoma patients when combined with conventional clinic
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NEURO
Radiomics may increase the prognostic value for survival in glioblastoma patients when combined with conventional clinical and genetic prognostic models Yangsean Choi 1 & Yoonho Nam 2 & Jinhee Jang 1 & Na-Young Shin 1 & Youn Soo Lee 3 & Kook-Jin Ahn 1 Jae-Sung Park 4 & Sin-soo Jeon 4 & Yong Gil Hong 4
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& Bum-soo Kim &
Received: 27 May 2020 / Revised: 10 August 2020 / Accepted: 21 September 2020 # European Society of Radiology 2020
Abstract Objectives To evaluate the additional prognostic value of multiparametric MR-based radiomics in patients with glioblastoma when combined with conventional clinical and genetic prognostic factors. Methods In this single-center study, patients diagnosed with glioblastoma between October 2007 and December 2019 were retrospectively screened and grouped into training and test sets with a 7:3 distribution. Segmentations of glioblastoma using multiparametric MRI were performed automatically via a convolutional-neural network. Prognostic factors in the clinical model included age, sex, type of surgery/post-operative treatment, and tumor location; those in the genetic model included statuses of isocitrate dehydrogenase-1 mutation and O-6-methylguanine-DNA-methyltransferase promoter methylation. Univariate and multivariate Cox proportional hazards analyses were performed for overall survival (OS) and progression-free survival (PFS). Integrated time-dependent area under the curve (iAUC) for survival was calculated and compared between prognostic models via the bootstrapping method (performances were validated with prediction error curves). Results Overall, 120 patients were included (training set, 85; test set, 35). The mean OS and PFS were 25.5 and 18.6 months, respectively. The prognostic performances of multivariate models improved when radiomics was added to the clinical model (iAUC: OS, 0.62 to 0.73; PFS, 0.58 to 0.66), genetic model (iAUC: OS, 0.59 to 0.67; PFS, 0.59 to 0.65), and combined model (iAUC: OS, 0.65 to 0.73; PFS, 0.62 to 0.67). In the test set, the combined model (clinical, genetic, and radiomics) demonstrated robust validation for risk prediction of OS and PFS. Conclusions Radiomics increased the prognostic value when combined with conventional clinical and genetic prognostic models for OS and PFS in glioblastoma patients. Key Points • CNN-based automatic segmentation of glioblastoma on multiparametric MRI was useful in extracting radiomic features. • Patients with glioblastoma with high-risk radiomics scores had poor overall survival (hazards ratio 8.33, p < 0.001) and progression-free survival (hazards ratio 3.76, p < 0.001). • MR-based radiomics improved the survival prediction when combined with clinical and genetic factors (overall and progression-free survival iAUC from 0.65 to 0.73 and 0.62 to 0.67, respectively; both p < 0.001).
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00330-020-07335-1) contains supplementary material, which is available to authorized users. * Yoonho Nam [email protected]
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