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Li Z, Wang R, Wang L, Tan C, Xu J, Fang J, Xian J. Machine Learning-Based MRI Radiogenomics for Evaluation of Response to Induction Chemotherapy in Head and Neck Squamous Cell Carcinoma. Acad Radiol 2023:S1076-6332(23)00609-8. [PMID: 37985290 DOI: 10.1016/j.acra.2023.10.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 10/16/2023] [Accepted: 10/28/2023] [Indexed: 11/22/2023]
Abstract
RATIONALE AND OBJECTIVES To develop and validate a radiogenomics model integrating clinical data, radiomics-based machine learning (RBML) classifiers, and transcriptomics data for predicting the response to induction chemotherapy (IC) in patients with head and neck squamous cell carcinoma (HNSCC). MATERIALS AND METHODS Radiomics features derived from T2-weighted, pre- and post-contrast-enhanced T1-weighted MRI sequences, clinical data, and RNA sequencing data of 150 patients with HNSCC were included in the study. Analysis of variance or recursive feature elimination was used to reduce radiomics features. Three RBML classifiers were developed to distinguish non-responders from responders. Weighted correlation network analysis (WGCNA) was performed to identify the correlation between clinical data or radiomics features and molecular features; subsequently, protein interaction and functional enrichment analyses were performed. The predictive performance of the radiogenomics model integrating significant clinical variables, RBML classifiers, and molecular features was evaluated using receiver operating characteristic curve analysis. RESULTS Five radiomics features and two conventional MRI findings significantly stratified HNSCC patients into responders and non-responders. On WGCNA analysis, 809 genes showed a significant correlation with two radiomics features. Functional enrichment analysis suggested that our proposed radiomics features could reflect the T cell-mediated immune response and immune infiltration of HNSCC. The radiogenomics model showed the highest area under the curve (0.88[95%CI 0.75-0.96]) for predicting IC response, which was better than MRI findings(p = 0.0407) or molecular features(p = 0.004) alone, but showed no significant difference with that of RBML model (p = 0.2254) in test cohort. CONCLUSION Merging imaging phenotypes with transcriptomic data improved the prediction of IC response in HNSCC.
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Affiliation(s)
- Zheng Li
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing, China (Z.L., J.X.).
| | - Ru Wang
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China (R.W., L.W., C.T., J.X., J.F.).
| | - Lingwa Wang
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China (R.W., L.W., C.T., J.X., J.F.).
| | - Chen Tan
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China (R.W., L.W., C.T., J.X., J.F.).
| | - Jiaqi Xu
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China (R.W., L.W., C.T., J.X., J.F.).
| | - Jugao Fang
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China (R.W., L.W., C.T., J.X., J.F.).
| | - Junfang Xian
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing, China (Z.L., J.X.).
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Sistonen HJ, Ilmarinen T, Atula T, Aro K, Schildt J, Markkola A. PET-CT detection of local residual laryngeal carcinoma after definitive (chemo)radiotherapy. BMC Cancer 2023; 23:358. [PMID: 37072716 PMCID: PMC10111680 DOI: 10.1186/s12885-023-10834-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 04/11/2023] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND Positron emission tomography and computed tomography (PET-CT) is currently recommended in evaluating the treatment response after (chemo)radiotherapy ([C]RT). In the larynx, post-treatment changes and physiological uptake make image interpretation more challenging compared to other head and neck sites. Previous research has not addressed imaging factors specifically in the larynx that would help in distinguishing the residual disease and explain the unique challenges of that anatomic area. The study cohorts are small and heterogenous. Our objective was to investigate the ability of PET-CT in diagnosing local residual laryngeal carcinoma, and to uncover imaging factors that could be used in differentiating the residual disease from post-treatment and physiological changes. In the same study cohort, we also aimed to uncover prognostic factors for local residual or recurrent disease. METHODS Our retrospective study cohort included 73 patients with T2-T4 laryngeal carcinoma undergoing (C)RT with curative intention, and post-treatment non-contrast-enhanced PET-CT at 2-6 months. Findings were compared between local residual and non-residual disease. Local residual disease was defined as a persistent tumor growth with no evidence of remission in between, confirmed by biopsy, and evident within 6 months from the end of RT. PET-CT was evaluated using a 3-step scale: negative, equivocal, and positive. RESULTS Nine (12%) had a local residual tumor and 11 (15%) developed local recurrence, based on the biopsy. The median follow-up of surviving patients was 64 months (range, 28-174). In univariate analysis, primary tumor diameter greater than 2.4 cm (median value), and vocal cord fixation were prognostic for local residual or recurrent disease. Sensitivity, specificity, PPV, and NPV were 100%, 75%, 36%, and 100%, respectively, when the equivocal interpretation was grouped with the positive interpretation. All local residuals, and 28% (18/64) non-residuals, had a primary tumor area SUVmax of over 4.0 (p < 0.001). CT showed a persistent mass at the primary tumor area in 56% of residuals, and in 23% of non-residuals (p > 0.05). By combining SUVmax>4.0 and mass, specificity improved to 91%. CONCLUSIONS NPV of post-treatment PET-CT in laryngeal carcinoma is high, but equivocal and positive results have low PPV and require further diagnostics. All local residuals had SUVmax over 4.0. The combination of SUVmax over 4.0 and mass on CT increased specificity, but the sensitivity was low.
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Affiliation(s)
- Heli J Sistonen
- Department of Radiology, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 4, Helsinki, 00029 HUS, Finland.
| | - Taru Ilmarinen
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Kasarmikatu 11-13, Helsinki, 00029 HUS, Finland
| | - Timo Atula
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Kasarmikatu 11-13, Helsinki, 00029 HUS, Finland
| | - Katri Aro
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Kasarmikatu 11-13, Helsinki, 00029 HUS, Finland
| | - Jukka Schildt
- Department of Nuclear Medicine, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 4, Helsinki, 00029 HUS, Finland
| | - Antti Markkola
- Department of Radiology, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 4, Helsinki, 00029 HUS, Finland
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Guo L, Fu Y, Miao C, Wu S, Zhu Y, Liu Y. Second Primary Malignancy in Patients with Hypopharyngeal Carcinoma: A SEER-Based Study. Int J Gen Med 2021; 14:8847-8861. [PMID: 34858052 PMCID: PMC8630468 DOI: 10.2147/ijgm.s339595] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 11/04/2021] [Indexed: 12/19/2022] Open
Abstract
Background A population-based analysis of the risk of secondary primary malignancy (SPM) in patients with hypopharyngeal carcinoma (HPC) has been lacking in the literature. Therefore, we conducted this study to determine the risk factors and assess the effects of SPM on the overall survival (OS) and cancer-specific survival (CSS) of patients with HPC. Methods Data on selected patients diagnosed with HPC from the Surveillance, Epidemiology and End Results (SEER) database between 1973 and 2015 were examined through logistic regression, Cox regression and nomogram methods. Results The overall risk of SPM in patients with HPC was higher than that in the general population (SIR: 2.77; P < 0.05). The specific-site, including the oral cavity, pharynx, digestive system, respiratory system and endocrine system, had a relatively higher risk of SPM. The overall risks of the subgroup of people 55–75 years of age and all subgroups of sex, race and latency were significantly elevated. In addition, patients with HPC were more likely to have been diagnosed in 2010–2015 (vs 2004–2009; P = 0.002), to be unmarried (vs married; P = 0.008), to have distant metastasis (vs no metastasis; P = 0.016) and to have had no surgery for the first tumor (vs surgery for the first tumor; P = 0.021), and these aspects were associated with a significantly elevated risk of developing SPM. SPM was independently associated with better OS and CSS. The OS and CSS in patients with HPC with SPM were better than those in patients without SPM (log rank P < 0.0001). The C indexes of the nomogram constructed with ten influencing factors including SPM were 0.681:0.699 for OS and 0.705:0.724 for CSS (training cohort:validation cohort). Conclusion Although the overall risk of SPM in patients with HPC was elevated, SPM did not decrease the OS and CSS in patients with HPC. This finding is inconsistent with clinical observations and thus requires further research and exploration. It possibly because HPC might have a shorter survival time, or the follow-up time was not long enough.
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Affiliation(s)
- Liqing Guo
- Department of Otolaryngology, The Second Affiliated Hospital of Nanchang University, NanChang, 330006, JiangXi, People's Republic of China
| | - Yanpeng Fu
- Department of Otolaryngology, The Second Affiliated Hospital of Nanchang University, NanChang, 330006, JiangXi, People's Republic of China
| | - Chunyu Miao
- Department of Otolaryngology, Nanchang Affiliated Hospital of Sun Yat-Sen University, NanChang, 330009, JiangXi, People's Republic of China
| | - Shuhong Wu
- Department of Otolaryngology, The Second Affiliated Hospital of Nanchang University, NanChang, 330006, JiangXi, People's Republic of China
| | - Yaqiong Zhu
- Department of Otolaryngology, The Second Affiliated Hospital of Nanchang University, NanChang, 330006, JiangXi, People's Republic of China
| | - Yuehui Liu
- Department of Otolaryngology, The Second Affiliated Hospital of Nanchang University, NanChang, 330006, JiangXi, People's Republic of China
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Abstract
State-of-the-art MR imaging of the larynx and hypopharynx with high-resolution surface coils, parallel imaging techniques, and DWI has several advantages over CT for assessing submucosal tumor spread, in particular neoplastic involvement of the paraglottic space, laryngeal cartilages, and extralaryngeal soft tissues. Current diagnostic MR imaging criteria based on a combination of distinct imaging features on morphologic sequences combined with DWI allow improved discrimination between tumor, peritumoral inflammation, and fibrosis and, ultimately, an increased precision for submucosal tumor delineation, which is a key prerequisite for tailored treatment options. Multiparametric MR imaging with DWI has a higher diagnostic performance than CT.
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Affiliation(s)
- Minerva Becker
- Diagnostic Department, Division of Radiology, Unit of Head and Neck and Maxillo-facial Radiology, Geneva University Hospitals, University of Geneva, Rue Gabrielle-Perret-Gentil 4, Geneva 14, Geneva 1211, Switzerland.
| | - Yann Monnier
- Department of Clinical Neurosciences, Clinic of Otorhinolaryngology, Head and Neck Surgery, Unit of Cervicofacial Surgery, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, Geneva 14, Geneva 1211, Switzerland
| | - Claudio de Vito
- Diagnostic Department, Division of Clinical Pathology, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, Geneva 14, Geneva 1211, Switzerland
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Smits HJG, Assili S, Kauw F, Philippens MEP, de Bree R, Dankbaar JW. Prognostic imaging variables for recurrent laryngeal and hypopharyngeal carcinoma treated with primary chemoradiotherapy: A systematic review and meta-analysis. Head Neck 2021; 43:2202-2215. [PMID: 33797818 PMCID: PMC8252607 DOI: 10.1002/hed.26698] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/09/2021] [Accepted: 03/16/2021] [Indexed: 01/10/2023] Open
Abstract
Background In this systematic review, we aim to identify prognostic imaging variables of recurrent laryngeal or hypopharyngeal carcinoma after chemoradiotherapy. Methods A systematic search was performed in PubMed and EMBASE (1990–2020). The crude data and effect estimates were extracted for each imaging variable. The level of evidence of each variable was assessed and pooled risk ratios (RRs) were calculated. Results Twenty‐two articles were included in this review, 17 on computed tomography (CT) and 5 on magnetic resonance imaging (MRI) variables. We found strong evidence for the prognostic value of tumor volume at various cut‐off points (pooled RRs ranging from 2.09 to 3.03). Anterior commissure involvement (pooled RR 2.19), posterior commissure involvement (pooled RR 2.44), subglottic extension (pooled RR 2.25), and arytenoid cartilage extension (pooled RR 2.10) were also strong prognostic factors. Conclusion Pretreatment tumor volume and involvement of several subsites are prognostic factors for recurrent laryngeal or hypopharyngeal carcinoma after chemoradiotherapy.
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Affiliation(s)
- Hilde J G Smits
- Department of Radiology, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - Sanam Assili
- Department of Radiology, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - Frans Kauw
- Department of Radiology, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - Marielle E P Philippens
- Department of Radiology, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - Jan W Dankbaar
- Department of Radiology, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
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