[18F]FDG PET radiomics to predict disease-free survival in cervical cancer: a multi-scanner/center study with external validation

Marta Ferreira (1) , Pierre Lovinfosse (2) , Johanne Hermesse (2) , Marjolein Decuypere (2) , Caroline Rousseau (3, 4) , François Lucia (5, 6) , Ulrike Schick (5, 6) , Caroline Reinhold (7) , Philippe Robin (5, 8) , Mathieu Hatt (6) , Dimitris Visvikis (6) , Claire Bernard (2) , Ralph T H Leijenaar (9) , Frédéric Kridelka (2) , Philippe Lambin (9) , Patrick E Meyer (10) , Roland Hustinx (1)

1 GIGA [Université Liège]
2 CHU-Liège - Centre Hospitalier Universitaire de Liège
3 CRCINA-ÉQUIPE 13 - Nuclear Oncology
4 CRLCC René Gauducheau
5 CHRU Brest - Centre Hospitalier Régional Universitaire de Brest
6 LaTIM - Laboratoire de Traitement de l'Information Medicale
7 MUHC - McGill University Health Center [Montreal]
8 GETBO - Groupe d'Etude de la Thrombose de Bretagne Occidentale
9 MUMC - Maastricht University Medical Centre
10 Université de Liège

Purpose To test the performances of native and tumour to liver ratio (TLR) radiomic features extracted from pre-treatment 2-[ 18 F] fluoro-2-deoxy-D-glucose ([ 18 F]FDG) PET/CT and combined with machine learning (ML) for predicting cancer recurrence in patients with locally advanced cervical cancer (LACC). Methods One hundred fifty-eight patients with LACC from multiple centers were retrospectively included in the study. Tumours were segmented using the Fuzzy Local Adaptive Bayesian (FLAB) algorithm. Radiomic features were extracted from the tumours and from regions drawn over the normal liver. Cox proportional hazard model was used to test statistical significance of clinical and radiomic features. Fivefold cross validation was used to tune the number of features. Seven different feature selection methods and four classifiers were tested. The models with the selected features were trained using bootstrapping and tested in data from each scanner independently. Reproducibility of radiomics features, clinical data added value and effect of ComBat-based harmonisation were evaluated across scanners. Results After a median follow-up of 23 months, 29% of the patients recurred. No individual radiomic or clinical features were significantly associated with cancer recurrence. The best model was obtained using 10 TLR features combined with clinical information. The area under the curve (AUC), F 1-score, precision and recall were respectively 0.78 (0.67-0.88), 0.49 (0.25-0.67), 0.42 (0.25-0.60) and 0.63 (0.20-0.80). ComBat did not improve the predictive performance of the best models. Both the TLR and the native models performance varied across scanners used in the test set. Conclusion [ 18 F]FDG PET radiomic features combined with ML add relevant information to the standard clinical parameters in terms of LACC patient's outcome but remain subject to variability across PET/CT devices.

Mots clés: Radiomics; [18F]FDG PET/CT; Cervical cancer; Disease-free survival; Machine learning

Domaines: Cancer

Marta Ferreira, Pierre Lovinfosse, Johanne Hermesse, Marjolein Decuypere, Caroline Rousseau, et al.. [18F]FDG PET radiomics to predict disease-free survival in cervical cancer: a multi-scanner/center study with external validation. European Journal of Nuclear Medicine and Molecular Imaging, 2021, 48 (11), pp.3432 - 3443. ⟨10.1007/s00259-021-05303-5⟩. ⟨inserm-03541325⟩