MRI‐based radiomic signatures for pretreatment prognostication in cervical cancer

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 ...