A multiple-time-scale comparative study for the added value of magnetic resonance imaging-based radiomics in predicting pathological complete response after neoadjuvant chemoradiotherapy in locally advanced rectal cancer

Objective: Radiomics based on magnetic resonance imaging (MRI) shows potential for prediction of therapeutic effect to neoadjuvant chemoradiotherapy (nCRT) in locally advanced rectal cancer (LARC); however, thorough comparison between radiomics and traditional models is deficient. We aimed to construct multiple- time-scale (pretreatment, posttreatment, and combined) radiomic models to predict pathological complete response (pCR) and compare their utility to those of traditional clinical models. Methods: In this research, 165 LARC patients undergoing nCRT followed by surgery were enrolled retrospectively, which were divided into training and testing sets in the ratio of 7: 3. Morphological features on pre- and posttreatment MRI, coupled with clinical data, were evaluated by univariable and multivariable logistic regression analysis for constructing clinical models. Radiomic parameters were derived from pre- and posttreatment T2- and diffusion-weighted images to develop the radiomic signatures. The clinicalradiomics models were then generated. All the models were developed in the training set and then tested in the testing set, the performance of which was assessed using the area under the receiver operating characteristic curve (AUC). Radiomic models were compared with the clinical models with the DeLong test. Results: One hundred and sixty-five patients (median age, 55 years; age interquartile range, 47-62 years; 116 males) were enrolled in the study. The pretreatment maximum tumor length, posttreatment maximum tumor length, and magnetic resonance tumor regression grade were selected as independent predictors for pCR in the clinical models. In the testing set, the pre- and posttreatment and combined clinical models generated AUCs of 0.625, 0.842, and 0.842 for predicting pCR, respectively. The MRI-based radiomic models performed reasonably well in predicting pCR, but neither the pure radiomic signatures (AUCs, 0.734, 0.817, and 0.801 for the pre- and posttreatment and combined radiomic signatures, respectively) nor the clinical-radiomics models (AUCs, 0.734, 0.860, and 0.801 for the pre- and posttreatment and combined clinical-radiomics models, respectively) showed significant added value compared with the clinical models (all P > 0.05). Conclusion: The MRI-based radiomic models exhibited no definite added value compared with the clinical models for predicting pCR in LARC. Radiomic models can serve as ancillary tools for tailoring adequate treatment strategies.

Automated summary

This study aimed to compare the utility of radiomics models and traditional clinical models in predicting the therapeutic effect of neoadjuvant chemoradiotherapy for locally advanced rectal cancer. The results showed that MRI-based radiomic models did not provide definite added value compared to clinical models, but they can serve as ancillary tools for tailoring treatment strategies.