Preoperative prediction of the Lauren classification in gastric cancer using automated nnU-Net and radiomics: a multicenter study.

Objectives: To develop and validate a deep learning model based on nnU-Net combined with radiomics to achieve autosegmentation of gastric cancer (GC) and preoperative prediction via the Lauren classification.

Methods: Patients with a pathological diagnosis of GC were retrospectively enrolled in three medical centers. The nnU-Net autosegmentation model was developed using manually segmented datasets and evaluated by the Dice similarity coefficient (DSC). The CT images were processed by the nnU-Net model to obtain autosegmentation results and extract radiomic features. The least absolute shrinkage and selection operator (LASSO) method selects optimal features for calculating the Radscore and constructing a radiomic model. Clinical characteristics and the Radscore were integrated to construct a combined model. Model performance was evaluated via the receiver operating characteristic (ROC) curve.

Results: A total of 433 GC patients were divided into the training set, internal validation set, external test set-1, and external test set-2. The nnU-Net model achieved a DSC of 0.79 in the test set. The areas under the curve (AUCs) of the internal validation set, external test set-1, and external test set-2 were 0.84, 0.83, and 0.81, respectively, for the radiomic model; and 0.81, 0.81, and 0.82, respectively, for the combined model. The AUCs of the radiomic and combined models showed no statistically significant difference (p > 0.05). The radiomic model was selected as the optimal model.

Conclusions: The nnU-Net model can efficiently and accurately achieve automatic segmentation of GCs. The radiomic model can preoperatively predict the Lauren classification of GC with high accuracy.

Critical relevance statement: This study highlights the potential of nnU-Net combined with radiomics to noninvasively predict the Lauren classification in gastric cancer patients, enhancing personalized treatment strategies and improving patient management.

Key points: The Lauren classification influences gastric cancer treatment and prognosis. The nnU-Net model reduces doctors' manual segmentation errors and workload. Radiomics models aid in preoperative Lauren classification prediction for patients with gastric cancer.