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Zhang Z, Wang J, Dai D, Xia F, Sun Y, Li G, Wan J, Shen L, Zhang H, Wang Y, Zhong J, Bao J, Zhang Z. Radiomic score for lung nodules as a prognostic biomarker in locally advanced rectal cancer patients: A bi-institutional study. Cancer Med 2024; 13:e7240. [PMID: 38923236 PMCID: PMC11196379 DOI: 10.1002/cam4.7240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 01/31/2024] [Accepted: 04/23/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Undetermined lung nodules are common in locally advanced rectal cancer (LARC) and lack precise risk stratification. This study aimed to develop a radiomic-based score (Rad-score) to distinguish metastasis and predict overall survival (OS) in patients with LARC and lung nodules. METHODS Retrospective data from two institutions (July 10, 2006-September 24, 2015) was used to develop and validate the Rad-score for distinguishing lung nodule malignancy. The prognostic value of the Rad-score was investigated in LARC cohorts, leading to the construction and validation of a clinical and radiomic score (Cli-Rad-score) that incorporates both clinical and radiomic information for the purpose of improving personalized clinical prognosis prediction. Descriptive statistics, survival analysis, and model comparison were performed to assess the results. RESULTS The Rad-score demonstrated great performance in distinguishing malignancy, with C-index values of 0.793 [95% CI: 0.729-0.856] in the training set and 0.730 [95% CI: 0.666-0.874] in the validation set. In independent LARC cohorts, Rad-score validation achieved C-index values of 0.794 [95% CI: 0.737-0.851] and 0.747 [95% CI: 0.615-0.879]. Regarding prognostic prediction, Rad-score effectively stratified patients. Cli-Rad-score outperformed the clinicopathological information alone in risk stratification, as evidenced by significantly higher C-index values (0.735 vs. 0.695 in the internal set and 0.618 vs. 0.595 in the external set). CONCLUSIONS CT-based radiomics could serve as a reliable and powerful tool for lung nodule malignancy distinction and prognostic prediction in LARC patients. Rad-score predicts prognosis independently. Incorporation of Cli-Rad-score significantly enhances the persionalized clinical prognostic capacity in LARC patients with lung nodules.
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Affiliation(s)
- Zhiyuan Zhang
- Department of Radiation OncologyFudan University Shanghai Cancer CenterShanghaiChina
- Department of Oncology, Shanghai Medical CollegeFudan UniversityShanghaiChina
- Shanghai Clinical Research Center for Radiation OncologyShanghaiChina
- Shanghai Key Laboratory of Radiation OncologyShanghaiChina
| | - Jiazhou Wang
- Department of Radiation OncologyFudan University Shanghai Cancer CenterShanghaiChina
- Department of Oncology, Shanghai Medical CollegeFudan UniversityShanghaiChina
- Shanghai Clinical Research Center for Radiation OncologyShanghaiChina
- Shanghai Key Laboratory of Radiation OncologyShanghaiChina
| | - Di Dai
- Department of RadiologyNanjing Medical University Affiliated Cancer Hospital, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer ResearchNanjingChina
| | - Fan Xia
- Department of Radiation OncologyFudan University Shanghai Cancer CenterShanghaiChina
- Department of Oncology, Shanghai Medical CollegeFudan UniversityShanghaiChina
- Shanghai Clinical Research Center for Radiation OncologyShanghaiChina
- Shanghai Key Laboratory of Radiation OncologyShanghaiChina
| | - Yiqun Sun
- Department of Oncology, Shanghai Medical CollegeFudan UniversityShanghaiChina
- Shanghai Institute of Medical ImagingFudan UniversityShanghaiChina
- Department of RadiologyFudan University Shanghai Cancer CenterShanghaiChina
| | - Guichao Li
- Department of Radiation OncologyFudan University Shanghai Cancer CenterShanghaiChina
- Department of Oncology, Shanghai Medical CollegeFudan UniversityShanghaiChina
- Shanghai Clinical Research Center for Radiation OncologyShanghaiChina
- Shanghai Key Laboratory of Radiation OncologyShanghaiChina
| | - Juefeng Wan
- Department of Radiation OncologyFudan University Shanghai Cancer CenterShanghaiChina
- Department of Oncology, Shanghai Medical CollegeFudan UniversityShanghaiChina
- Shanghai Clinical Research Center for Radiation OncologyShanghaiChina
- Shanghai Key Laboratory of Radiation OncologyShanghaiChina
| | - Lijun Shen
- Department of Radiation OncologyFudan University Shanghai Cancer CenterShanghaiChina
- Department of Oncology, Shanghai Medical CollegeFudan UniversityShanghaiChina
- Shanghai Clinical Research Center for Radiation OncologyShanghaiChina
- Shanghai Key Laboratory of Radiation OncologyShanghaiChina
| | - Hui Zhang
- Department of Radiation OncologyFudan University Shanghai Cancer CenterShanghaiChina
- Department of Oncology, Shanghai Medical CollegeFudan UniversityShanghaiChina
- Shanghai Clinical Research Center for Radiation OncologyShanghaiChina
- Shanghai Key Laboratory of Radiation OncologyShanghaiChina
| | - Yan Wang
- Department of Radiation OncologyFudan University Shanghai Cancer CenterShanghaiChina
- Department of Oncology, Shanghai Medical CollegeFudan UniversityShanghaiChina
- Shanghai Clinical Research Center for Radiation OncologyShanghaiChina
- Shanghai Key Laboratory of Radiation OncologyShanghaiChina
| | - Jie Zhong
- Department of OncologyNanjing Medical University Affiliated Cancer Hospital, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer ResearchNanjingChina
| | - Jun Bao
- Department of OncologyNanjing Medical University Affiliated Cancer Hospital, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer ResearchNanjingChina
| | - Zhen Zhang
- Department of Radiation OncologyFudan University Shanghai Cancer CenterShanghaiChina
- Department of Oncology, Shanghai Medical CollegeFudan UniversityShanghaiChina
- Shanghai Clinical Research Center for Radiation OncologyShanghaiChina
- Shanghai Key Laboratory of Radiation OncologyShanghaiChina
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Collins GS, Whittle R, Bullock GS, Logullo P, Dhiman P, de Beyer JA, Riley RD, Schlussel MM. Open science practices need substantial improvement in prognostic model studies in oncology using machine learning. J Clin Epidemiol 2024; 165:111199. [PMID: 37898461 DOI: 10.1016/j.jclinepi.2023.10.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 10/06/2023] [Accepted: 10/20/2023] [Indexed: 10/30/2023]
Abstract
OBJECTIVE To describe the frequency of open science practices in a contemporary sample of studies developing prognostic models using machine learning methods in the field of oncology. STUDY DESIGN AND SETTING We conducted a systematic review, searching the MEDLINE database between December 1, 2022, and December 31, 2022, for studies developing a multivariable prognostic model using machine learning methods (as defined by the authors) in oncology. Two authors independently screened records and extracted open science practices. RESULTS We identified 46 publications describing the development of a multivariable prognostic model. The adoption of open science principles was poor. Only one study reported availability of a study protocol, and only one study was registered. Funding statements and conflicts of interest statements were common. Thirty-five studies (76%) provided data sharing statements, with 21 (46%) indicating data were available on request to the authors and seven declaring data sharing was not applicable. Two studies (4%) shared data. Only 12 studies (26%) provided code sharing statements, including 2 (4%) that indicated the code was available on request to the authors. Only 11 studies (24%) provided sufficient information to allow their model to be used in practice. The use of reporting guidelines was rare: eight studies (18%) mentioning using a reporting guideline, with 4 (10%) using the Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis Or Diagnosis statement, 1 (2%) using Minimum Information About Clinical Artificial Intelligence Modeling and Consolidated Standards Of Reporting Trials-Artificial Intelligence, 1 (2%) using Strengthening The Reporting Of Observational Studies In Epidemiology, 1 (2%) using Standards for Reporting Diagnostic Accuracy Studies, and 1 (2%) using Transparent Reporting of Evaluations with Nonrandomized Designs. CONCLUSION The adoption of open science principles in oncology studies developing prognostic models using machine learning methods is poor. Guidance and an increased awareness of benefits and best practices of open science are needed for prediction research in oncology.
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Affiliation(s)
- Gary S Collins
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Centre for Statistics in Medicine, University of Oxford, Oxford, United Kingdom.
| | - Rebecca Whittle
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Centre for Statistics in Medicine, University of Oxford, Oxford, United Kingdom
| | - Garrett S Bullock
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA; Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, University of Oxford, Oxford, United Kingdom
| | - Patricia Logullo
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Centre for Statistics in Medicine, University of Oxford, Oxford, United Kingdom
| | - Paula Dhiman
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Centre for Statistics in Medicine, University of Oxford, Oxford, United Kingdom
| | - Jennifer A de Beyer
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Centre for Statistics in Medicine, University of Oxford, Oxford, United Kingdom
| | - Richard D Riley
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Michael M Schlussel
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Centre for Statistics in Medicine, University of Oxford, Oxford, United Kingdom
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Ma S, Lu H, Jing G, Li Z, Zhang Q, Ma X, Chen F, Shao C, Lu Y, Wang H, Shen F. Deep learning-based clinical-radiomics nomogram for preoperative prediction of lymph node metastasis in patients with rectal cancer: a two-center study. Front Med (Lausanne) 2023; 10:1276672. [PMID: 38105891 PMCID: PMC10722265 DOI: 10.3389/fmed.2023.1276672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 11/13/2023] [Indexed: 12/19/2023] Open
Abstract
Background Precise preoperative evaluation of lymph node metastasis (LNM) is crucial for ensuring effective treatment for rectal cancer (RC). This research aims to develop a clinical-radiomics nomogram based on deep learning techniques, preoperative magnetic resonance imaging (MRI) and clinical characteristics, enabling the accurate prediction of LNM in RC. Materials and methods Between January 2017 and May 2023, a total of 519 rectal cancer cases confirmed by pathological examination were retrospectively recruited from two tertiary hospitals. A total of 253 consecutive individuals were selected from Center I to create an automated MRI segmentation technique utilizing deep learning algorithms. The performance of the model was evaluated using the dice similarity coefficient (DSC), the 95th percentile Hausdorff distance (HD95), and the average surface distance (ASD). Subsequently, two external validation cohorts were established: one comprising 178 patients from center I (EVC1) and another consisting of 88 patients from center II (EVC2). The automatic segmentation provided radiomics features, which were then used to create a Radscore. A predictive nomogram integrating the Radscore and clinical parameters was constructed using multivariate logistic regression. Receiver operating characteristic (ROC) curve analysis and decision curve analysis (DCA) were employed to evaluate the discrimination capabilities of the Radscore, nomogram, and subjective evaluation model, respectively. Results The mean DSC, HD95 and ASD were 0.857 ± 0.041, 2.186 ± 0.956, and 0.562 ± 0.194 mm, respectively. The nomogram, which incorporates MR T-stage, CEA, CA19-9, and Radscore, exhibited a higher area under the ROC curve (AUC) compared to the Radscore and subjective evaluation in the training set (0.921 vs. 0.903 vs. 0.662). Similarly, in both external validation sets, the nomogram demonstrated a higher AUC than the Radscore and subjective evaluation (0.908 vs. 0.735 vs. 0.640, and 0.884 vs. 0.802 vs. 0.734). Conclusion The application of the deep learning method enables efficient automatic segmentation. The clinical-radiomics nomogram, utilizing preoperative MRI and automatic segmentation, proves to be an accurate method for assessing LNM in RC. This approach has the potential to enhance clinical decision-making and improve patient care. Research registration unique identifying number UIN Research registry, identifier 9158, https://www.researchregistry.com/browse-the-registry#home/registrationdetails/648e813efffa4e0028022796/.
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Affiliation(s)
- Shiyu Ma
- Department of Radiology, Changhai Hospital, The Navy Medical University, Shanghai, China
| | - Haidi Lu
- Department of Radiology, Changhai Hospital, The Navy Medical University, Shanghai, China
| | - Guodong Jing
- Department of Radiology, Changhai Hospital, The Navy Medical University, Shanghai, China
| | - Zhihui Li
- Department of Radiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Qianwen Zhang
- Department of Radiology, Changhai Hospital, The Navy Medical University, Shanghai, China
| | - Xiaolu Ma
- Department of Radiology, Changhai Hospital, The Navy Medical University, Shanghai, China
| | - Fangying Chen
- Department of Radiology, Changhai Hospital, The Navy Medical University, Shanghai, China
| | - Chengwei Shao
- Department of Radiology, Changhai Hospital, The Navy Medical University, Shanghai, China
| | - Yong Lu
- Department of Radiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Hao Wang
- Department of Colorectal Surgery, Changhai Hospital, The Navy Medical University, Shanghai, China
| | - Fu Shen
- Department of Radiology, Changhai Hospital, The Navy Medical University, Shanghai, China
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Tian C, Ma X, Lu H, Wang Q, Shao C, Yuan Y, Shen F. Deep learning models for preoperative T-stage assessment in rectal cancer using MRI: exploring the impact of rectal filling. Front Med (Lausanne) 2023; 10:1326324. [PMID: 38105894 PMCID: PMC10722089 DOI: 10.3389/fmed.2023.1326324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 11/14/2023] [Indexed: 12/19/2023] Open
Abstract
Background The objective of this study was twofold: firstly, to develop a convolutional neural network (CNN) for automatic segmentation of rectal cancer (RC) lesions, and secondly, to construct classification models to differentiate between different T-stages of RC. Additionally, it was attempted to investigate the potential benefits of rectal filling in improving the performance of deep learning (DL) models. Methods A retrospective study was conducted, including 317 consecutive patients with RC who underwent MRI scans. The datasets were randomly divided into a training set (n = 265) and a test set (n = 52). Initially, an automatic segmentation model based on T2-weighted imaging (T2WI) was constructed using nn-UNet. The performance of the model was evaluated using the dice similarity coefficient (DSC), the 95th percentile Hausdorff distance (HD95), and the average surface distance (ASD). Subsequently, three types of DL-models were constructed: Model 1 trained on the total training dataset, Model 2 trained on the rectal-filling dataset, and Model 3 trained on the non-filling dataset. The diagnostic values were evaluated and compared using receiver operating characteristic (ROC) curve analysis, confusion matrix, net reclassification index (NRI), and decision curve analysis (DCA). Results The automatic segmentation showed excellent performance. The rectal-filling dataset exhibited superior results in terms of DSC and ASD (p = 0.006 and 0.017). The DL-models demonstrated significantly superior classification performance to the subjective evaluation in predicting T-stages for all test datasets (all p < 0.05). Among the models, Model 1 showcased the highest overall performance, with an area under the curve (AUC) of 0.958 and an accuracy of 0.962 in the filling test dataset. Conclusion This study highlighted the utility of DL-based automatic segmentation and classification models for preoperative T-stage assessment of RC on T2WI, particularly in the rectal-filling dataset. Compared with subjective evaluation, the models exhibited superior performance, suggesting their noticeable potential for enhancing clinical diagnosis and treatment practices.
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Affiliation(s)
- Chang Tian
- School of Information Science and Technology and School of Biomedical Engineering, ShanghaiTech University, Shanghai, China
| | - Xiaolu Ma
- Department of Radiology, Changhai Hospital, The Navy Medical University, Shanghai, China
| | - Haidi Lu
- Department of Radiology, Changhai Hospital, The Navy Medical University, Shanghai, China
| | - Qian Wang
- School of Biomedical Engineering, ShanghaiTech University, Shanghai, China
| | - Chengwei Shao
- Department of Radiology, Changhai Hospital, The Navy Medical University, Shanghai, China
| | - Yuan Yuan
- Department of Radiology, Changhai Hospital, The Navy Medical University, Shanghai, China
| | - Fu Shen
- Department of Radiology, Changhai Hospital, The Navy Medical University, Shanghai, China
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