磁共振放射组学揭示了新辅助化疗的反应性，并揭示了人类乳头瘤病毒阳性口咽癌选择性去强化治疗的原理

IF 4 2区医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE

Oral oncology Pub Date : 2024-09-27 DOI:10.1016/j.oraloncology.2024.107049

Wenjiao Lyu , Jing Gong , Lin Zhu , Tingting Xu , Shenglin Huang , Chunying Shen , Cuihong Wang , Xiayun He , Hongmei Ying , Chaosu Hu , Yu Wang , Qinghai Ji , Yajia Gu , Xin Zhou , Xueguan Lu

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引用次数: 0

摘要

背景准确预测新辅助化疗（NAC）反应有助于在NAC指导下对HPV阳性口咽鳞癌（OPSCC）进行个性化的去强化治疗。本研究旨在应用基线磁共振放射组学特征预测NAC反应，以帮助选择NAC指导下的去强化治疗候选者，并探索反应导向放射组学的生物学基础。方法从复旦大学上海肿瘤防治中心获取131例HPV阳性口咽鳞癌患者的治疗前磁共振图像和临床数据。患者被分为训练队列（n = 47）、NAC反应适应性去强化试验（IChoice-01，NCT04012502）验证队列1（n = 49）和真实世界验证队列2（n = 35）。利用线性支持向量机（SVM）建立并验证了 NAC 预测模型。随后建立了结合放射组学和临床特征的提名图来预测生存结果。研究结果对于NAC反应预测，口咽和结节特征的融合模型在预测训练队列（AUC 0-89，95% CI，0-79-0-95）和验证队列1（AUC 0-71，95% CI，0-59-0-83）中的良好反应者方面取得了令人鼓舞的成绩。在预后预测方面，三个队列中基于放射组学的提名图在低风险和高风险患者之间表现出令人满意的鉴别能力（PFS，C-指数分别为0-85、0-76和0-83；OS，C-指数分别为0-79、0-76和0-87）。基于磁共振成像的放射组学模型和预后模型能有效区分不同NAC反应和生存风险的患者，有助于HPV阳性OPSCC患者的候选者选择，从而减轻个性化治疗的强度。

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MR radiomics unveils neoadjuvant chemo-responsiveness with insights into selective treatment de-intensification in HPV-positive oropharyngeal carcinoma

Background

Accurate prediction of neoadjuvant chemotherapy (NAC) response allows for NAC-guided personalized treatment de-intensification in HPV-positive oropharyngeal squamous cell carcinoma (OPSCC). In this study, we aimed to apply baseline MR radiomic features to predict NAC response to help select NAC-guided de-intensification candidates, and to explore biological underpinnings of response-oriented radiomics.

Methods

Pre-treatment MR images and clinical data of 131 patients with HPV-positive OPSCC were retrieved from Fudan University Shanghai Cancer Center. Patients were divided into training cohort (n = 47), validation cohort 1 (n = 49) from NAC response-adapted de-intensification trial (IChoice-01, NCT04012502) and real-world validation cohort 2 (n = 35). NAC prediction model using linear support vector machine (SVM) was built and validated. Subsequent nomograms combined radiomics and clinical characteristics were established to predict survival outcomes. RNA-seq and proteomic data were compared to interpret the molecular features underlying radiomic signatures with differential NAC response.

Findings

For NAC response prediction, the fusion model with both oropharyngeal and nodal signatures achieved encouraging performance to predict good responders in the training cohort (AUC 0·89, 95% CI, 0·79-0·95) and validation cohort 1 (AUC 0·71, 95% CI, 0·59-0·83). For prognosis prediction, radiomics-based nomograms exhibited satisfactory discriminative ability between low-risk and high-risk patients (PFS, C-index 0·85, 0·76 and 0·83; OS, C-index 0·79, 0·76 and 0·87, respectively) in three cohorts. Expression analysis unveiled NAC poor responders had predominantly enhanced keratinization while good responders were featured by upregulated immune response and oxidative stress.

Interpretation

The MR-based radiomic models and prognostic models efficiently discriminate among patients with different NAC response and survival risk, which help candidate selection in HPV-positive OPSCC with regard to personalized treatment de-intensification.

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来源期刊

Oral oncology 医学-牙科与口腔外科

CiteScore

8.70

自引率

10.40%

发文量

505

审稿时长

20 days

期刊介绍： Oral Oncology is an international interdisciplinary journal which publishes high quality original research, clinical trials and review articles, editorials, and commentaries relating to the etiopathogenesis, epidemiology, prevention, clinical features, diagnosis, treatment and management of patients with neoplasms in the head and neck. Oral Oncology is of interest to head and neck surgeons, radiation and medical oncologists, maxillo-facial surgeons, oto-rhino-laryngologists, plastic surgeons, pathologists, scientists, oral medical specialists, special care dentists, dental care professionals, general dental practitioners, public health physicians, palliative care physicians, nurses, radiologists, radiographers, dieticians, occupational therapists, speech and language therapists, nutritionists, clinical and health psychologists and counselors, professionals in end of life care, as well as others interested in these fields.