Personalizing adjuvant radiotherapy decisions in breast cancer: an externally test MRI radiomics approach for
Man Long1, Yu Xie1, Jinqiu Ruan2
1Department of Radiology, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, No.519 Kunzhou Road, Xishan District, Kunming, Yunnan, 650118, China.
Purpose:
To develop a radiomics signature based on preoperative MRI to predict recurrence-free survival (RFS) and which patients will benefit from adjuvant radiotherapy in breast cancer patients.
Experimental Design:
771 eligible patients from two independent centers were collected. The training set (n = 504) obtained was from the Yunnan Cancer Hospital, and the external test set (n = 267) was obtained from the Duke Breast Cancer MRI Study. Pearson correlation analysis and clustering were used to construct the radiomics signature Rad-score. Based on the best cut-off value, the patients were divided into a high-risk group and a low-risk group, and the prognostic value was evaluated. A combined model nomogram was developed based on the radiomics features incorporating independent clinicopathological risk factors. The combined model's performance was assessed regarding its discrimination, calibration, and clinical usefulness. Kaplan-Meier analysis was used to identify patients who benefited from adjuvant radiotherapy.
Results:
The high-risk group was significantly associated with worse RFS in the training and test sets (p = 0.001 and 0.048). The combination model can accurately predict BC recurrence risk (AUC, 0.752; 95% confidence interval [CI], 0.698-0.807). Additionally, adjuvant radiotherapy was not associated with the outcome of high-risk patients (training and test sets: p = 0.665 and 0.903, respectively). In the low-risk group, adjuvant radiotherapy was significantly associated with RFS (training and test sets: p = 0.004 and P＜0.001).
Conclusions:
The Rad-score can effectively predict the prognosis of patients with breast cancer, and identify high-risk patients who do not benefit from adjuvant radiotherapy.
Clinical Trial Number:
Not applicable.