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• Clinical Article •
The development and external validation of a model based on MRI quantification, pathology, and blood cell parameters to predict the efficacy of concurrent chemoradiotherapy for stage ⅡB-Ⅲ cervical cancer
WANG Yajing  LI Weilan  CHENG Huixin  CUI Liqiang  YU Hong  GUO Yanjuan  XIE Zongyuan 

WANG Y J, LI W L, CHENG H X, et al. The development and external validation of a model based on MRI quantification, pathology, and blood cell parameters to predict the efficacy of concurrent chemoradiotherapy for stage ⅡB-Ⅲ cervical cancer[J]. Chin J Magn Reson Imaging, 2023, 14(8): 86-93. DOI:10.12015/issn.1674-8034.2023.08.014.


[Abstract] Objective To develop and test a model for predicting the efficacy of concurrent chemoradiotherapy for stage ⅡB-Ⅲ cervical cancer based on quantitative MRI, pathology, and blood cell parameters.Materials and Methods From March 2020 to June 2022, clinical data from 151 cervical cancer patients at the North China University of Science and Technology Affiliated Hospital were analyzed retrospectively, and data from 93 cervical cancer patients at the Hebei General Hospital for Veterans were used for model external validation. To screen for risk factors associated with the efficacy of concurrent chemoradiotherapy, least absolute shrinkage and selection operator (LASSO) regression was used. The value of a risk factor model for the efficacy of concurrent chemoradiotherapy was evaluated using the consistency index (C-index), calibration curve, mean absolute error (MAE), and decision curve analysis (DCA).Results LASSO regression analysis revealed that elevated volume transport constant (Ktrans), apparent dispersion coefficient (ADC), and perfusion-related volume fraction (f) were independent factors for objective remission (OR) following concurrent chemoradiotherapy. High International Federation of Gynecology and Obstetrics (FIGO) staging, lymph node metastasis, elevated extravascular extracellular volume ratio (Ve), elevated slow ADC (D), and elevated monocyte to lymphocyte ratio (MLR) were all independent risk factors for OR after concurrent chemoradiotherapy. The C-index and MAE of model F (which included FIGO staging, lymph node metastasis, Ktrans, Ve, ADC, D, f, and MLR) were 0.984 and 0.033, respectively, which were higher than those of model S (which included Ktrans, Ve, ADC, D, and f; 0.940, 0.020) and model T (which included FIGO staging, lymph node metastasis, and MLR; 0.897, 0.020). The calibration curves showed that the calibration curve for model S overlapped with the ideal curve slightly better than the calibration curves for models F and T. Over the entire risk threshold range, the DCA showed that model F had a higher net benefit than model S and model T. Model F had a higher C-index (0.996) than model S (0.942) and model T (0.917) and a lower MAE (0.017) than model S (0.043) and model T (0.043), according to the model validation results. The calibration curves showed that the calibration curves for model F and model S overlapped with the ideal curve more closely than model T. Over the entire risk threshold range, the DCA showed that model F had a higher net benefit than model S and model T.Conclusions FIGO staging, lymph node metastasis, Ktrans, Ve, ADC, D, f, and MLR are associated with the efficacy of concurrent chemoradiotherapy for stage ⅡB-Ⅲ cervical cancer. The model based on the above indicators can aid in predicting the efficacy of concurrent chemoradiotherapy, and its efficacy is higher than that of the MRI-only quantitative parameter model and the pathology and blood cell parameter model.
[Keywords] cervical cancer；concurrent chemoradiotherapy；magnetic resonance imaging；model；pathology；blood cells；efficacy prediction；external validation

WANG Yajing1   LI Weilan1   CHENG Huixin2   CUI Liqiang2   YU Hong3   GUO Yanjuan4   XIE Zongyuan1*  

1 Department of MRI, North China University of Science and Technology Affiliated Hospital, Tangshan 063000, China

2 Department of CT/MRI, Hebei General Hospital for Veterans, Xingtai 054000, China

3 Department of MRI, Tangshan Caofeidian District Hospital, Tangshan 063200, China

4 Department of Gynecology, North China University of Science and Technology Affiliated Hospital, Tangshan 063000, China

Corresponding author: Xie ZY, E-mail: xied126@126.com

Conflicts of interest   None.

ACKNOWLEDGMENTS Medical Science Research Project of the Health Commission of Hebei Province (No. 20201245, 20231255).
Received  2023-03-02
Accepted  2023-07-21
DOI: 10.12015/issn.1674-8034.2023.08.014
WANG Y J, LI W L, CHENG H X, et al. The development and external validation of a model based on MRI quantification, pathology, and blood cell parameters to predict the efficacy of concurrent chemoradiotherapy for stage ⅡB-Ⅲ cervical cancer[J]. Chin J Magn Reson Imaging, 2023, 14(8): 86-93. DOI:10.12015/issn.1674-8034.2023.08.014.

[1]
SUNG H, FERLAY J, SIEGEL R L, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2021, 71(3): 209-249. DOI: 10.3322/caac.21660.
[2]
SIEGEL R L, MILLER K D, JEMAL A. Cancer statistics, 2016[J]. CA Cancer J Clin, 2016, 66(1): 7-30. DOI: 10.3322/caac.21332.
[3]
ZHANG S W, SUN K X, ZHENG R S, et al. Cancer incidence and mortality in China, 2015[J]. J Natl Cancer Cent, 2021, 1(1): 2-11. DOI: 10.1016/j.jncc.2020.12.001.
[4]
ABU-RUSTUM N R, YASHAR C M, BEAN S, et al. NCCN guidelines insights: cervical cancer, version 1.2020[J]. J Natl Compr Canc Netw, 2020, 18(6): 660-666. DOI: 10.6004/jnccn.2020.0027.
[5]
WESTERVELD H, NESVACIL N, FOKDAL L, et al. Definitive radiotherapy with image-guided adaptive brachytherapy for primary vaginal cancer[J/OL]. Lancet Oncol, 2020, 21(3): e157-e167 [2023-01-05]. https://www.thelancet.com/journals/lanonc/article/piis1470-2045(19)30855-1/fulltext. DOI: 10.1016/S1470-2045(19)30855-1.
[6]
ZHANG Y, LIU L, ZHANG K Y, et al. Nomograms combining clinical and imaging parameters to predict recurrence and disease-free survival after concurrent chemoradiotherapy in patients with locally advanced cervical cancer[J]. Acad Radiol, 2023, 30(3): 499-508. DOI: 10.1016/j.acra.2022.08.002.
[7]
MOSQUERA I, ILBAWI A, MUWONGE R, et al. Cancer burden and status of cancer control measures in fragile states: a comparative analysis of 31 countries[J/OL]. Lancet Glob Health, 2022, 10(10): e1443-e1452 [2023-01-05]. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9638035. DOI: 10.1016/S2214-109X(22)00331-X.
[8]
ZHENG X M, DONG J N, QIAN L T. Research progress of IVIM-DWI and DCE-MRI in evaluating the efficacy of concurrent chemoradiotherapy for locally advanced cervical cancer[J]. Int J Med Radiol, 2020, 43(3): 322-325. DOI: 10.19300/j.2020.Z17960.
[9]
MARKOVINA S, RENDLE K A, COHEN A C, et al. Improving cervical cancer survival-a multifaceted strategy to sustain progress for this global problem[J]. Cancer, 2022, 128(23): 4074-4084. DOI: 10.1002/cncr.34485.
[10]
ZHANG Y, ZHANG K Y, JIA H D, et al. IVIM-DWI and MRI-based radiomics in cervical cancer: prediction of concurrent chemoradiotherapy sensitivity in combination with clinical prognostic factors[J]. Magn Reson Imaging, 2022, 91: 37-44. DOI: 10.1016/j.mri.2022.05.005.
[11]
ZHENG X M, GUO W Q, DONG J N, et al. Prediction of early response to concurrent chemoradiotherapy in cervical cancer: value of multi-parameter MRI combined with clinical prognostic factors[J]. Magn Reson Imaging, 2020, 72: 159-166. DOI: 10.1016/j.mri.2020.06.014.
[12]
ZHANG X M, ZHANG Q, CHEN Y, et al. MRI-based radiomics for pretreatment prediction of response to concurrent chemoradiotherapy in locally advanced cervical squamous cell cancer[J]. Abdom Radiol, 2023, 48(1): 367-376. DOI: 10.1007/s00261-022-03665-4.
[13]
DENG X J, LIU M L, ZHOU Q, et al. Predicting treatment response to concurrent chemoradiotherapy in squamous cell carcinoma of the cervix using amide proton transfer imaging and intravoxel incoherent motion imaging[J]. Diagn Interv Imaging, 2022, 103(12): 618-624. DOI: 10.1016/j.diii.2022.09.001.
[14]
YI Q Q, ZHOU Z, LUO Y, et al. Construction of prediction model of intermediate risk factors for early cervical cancer based on preoperative MRI radiomics and clinical features[J]. Chin J Magn Reson Imag, 2022, 13(4): 124-127, 136. DOI: 10.12015/issn.1674-8034.2022.04.024.
[15]
LEE W H, KIM G E, KIM Y B. Prognostic factors of dose-response relationship for nodal control in metastatic lymph nodes of cervical cancer patients undergoing definitive radiotherapy with concurrent chemotherapy[J/OL]. J Gynecol Oncol, 2022, 33(5): e59 [2023-01-05]. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9428306. DOI: 10.3802/jgo.2022.33.e59.
[16]
GUO J F, LV W Q, WANG Z H, et al. Prognostic value of inflammatory and nutritional markers for patients with early-stage poorly-to moderately-differentiated cervical squamous cell carcinoma[J/OL]. Cancer Control, 2023, 30: 10732748221148913 [2023-01-05]. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9982384. DOI: 10.1177/10732748221148913.
[17]
CHENG M X, LI G L, LIU Z A, et al. Pretreatment neutrophil-to-lymphocyte ratio and lactate dehydrogenase predict the prognosis of metastatic cervical cancer treated with combination immunotherapy[J/OL]. J Oncol, 2022, 2022: 1828473 [2023-01-05]. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9596258. DOI: 10.1155/2022/1828473.
[18]
CHO O, CHUN M, CHANG S J. Exponential slope from absolute lymphocyte counts during radio-chemotherapy can predict an aggressive course of cervical cancer[J/OL]. Cancers, 2022, 14(20): 5109 [2023-01-05]. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9600990. DOI: 10.3390/cancers14205109.
[19]
WISDOM A J, HONG C S, LIN A J, et al. Neutrophils promote tumor resistance to radiation therapy[J]. Proc Natl Acad Sci U S A, 2019, 116(37): 18584-18589. DOI: 10.1073/pnas.1901562116.
[20]
NOMELINI R S, MOTA S D S, MURTA E F C. Absolute band neutrophils count is a predictor of overall survival in advanced uterine cervical cancer[J]. Arch Gynecol Obstet, 2022, 306(5): 1697-1701. DOI: 10.1007/s00404-022-06545-w.
[21]
LENG J L, WU F, ZHANG L H. Prognostic significance of pretreatment neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, or monocyte-to-lymphocyte ratio in endometrial neoplasms: a systematic review and meta-analysis[J/OL]. Front Oncol, 2022, 12: 734948 [2023-01-05]. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9149577. DOI: 10.3389/fonc.2022.734948.
[22]
EISENHAUER E A, THERASSE P, BOGAERTS J, et al. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1)[J]. Eur J Cancer, 2009, 45(2): 228-247. DOI: 10.1016/j.ejca.2008.10.026.
[23]
ZHANG X M, ZHANG Q, GUO J X, et al. Added-value of texture analysis of ADC in predicting the survival of patients with 2018 FIGO stage IIICr cervical cancer treated by concurrent chemoradiotherapy[J/OL]. Eur J Radiol, 2022, 150: 110272 [2023-01-05]. https://www.ejradiology.com/article/S0720-048X(22)00122-X/fulltext. DOI: 10.1016/j.ejrad.2022.110272.
[24]
ZHANG Q, GUO J X, OUYANG H, et al. Added-value of dynamic contrast-enhanced MRI on prediction of tumor recurrence in locally advanced cervical cancer treated with chemoradiotherapy[J]. Eur Radiol, 2022, 32(4): 2529-2539. DOI: 10.1007/s00330-021-08279-w.
[25]
QIN F Y, PANG H T, MA J T, et al. Combined dynamic contrast enhanced MRI parameter with clinical factors predict the survival of concurrent chemo-radiotherapy in patients with 2018 FIGO IIICr stage cervical cancer[J/OL]. Eur J Radiol, 2021, 141: 109787 [2023-01-05]. https://www.ejradiology.com/article/S0720-048X(21)00268-0/fulltext. DOI: 10.1016/j.ejrad.2021.109787.
[26]
MENG J, LIU S L, ZHU L J, et al. Texture Analysis as Imaging Biomarker for recurrence in advanced cervical cancer treated with CCRT[J/OL]. Sci Rep, 2018, 8(1): 11399 [2023-01-05]. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6065361. DOI: 10.1038/s41598-018-29838-0.
[27]
ZHANG X M, ZHANG Q, XIE L Z, et al. The value of whole-tumor texture analysis of ADC in predicting the early recurrence of locally advanced cervical squamous cell cancer treated with concurrent chemoradiotherapy[J/OL]. Front Oncol, 2022, 12: 852308 [2023-01-05]. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9165468. DOI: 10.3389/fonc.2022.852308.
[28]
LIANG B L, LAI S L, WANG Z, et al. The value of MRI-IVIM bi-index and stretch index models in predicting that early curative effect of locally advanced cervical cancer with concurrent chemoradiotherapy[J]. J Guangxi Med Univ, 2022, 39(8): 1284-1289. DOI: 10.16190/j.cnki.45-1211/r.2022.08.016.
[29]
LIU B, SUN Z, MA W L, et al. DCE-MRI quantitative parameters as predictors of treatment response in patients with locally advanced cervical squamous cell carcinoma underwent CCRT[J/OL]. Front Oncol, 2020, 10: 585738 [2023-01-05]. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7658627. DOI: 10.3389/fonc.2020.585738.
[30]
LU H M, WU Y Y, LIU X, et al. The role of dynamic contrast-enhanced magnetic resonance imaging in predicting treatment response for cervical cancer treated with concurrent chemoradiotherapy[J]. Cancer Manag Res, 2021, 13: 6065-6078. DOI: 10.2147/CMAR.S314289.
[31]
LI Y X, CHANG J Y, HE M Y, et al. Neutrophil-to-lymphocyte ratio (NLR) and monocyte-to-lymphocyte ratio (MLR) predict clinical outcome in patients with stage IIB cervical cancer[J/OL]. J Oncol, 2021, 2021: 2939162 [2023-01-05]. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8443385. DOI: 10.1155/2021/2939162.
[32]
TAGUCHI A, NAKAJIMA Y, FURUSAWA A, et al. High neutrophil-to-lymphocyte ratio is a predictor of short-term survival for patients with recurrent cervical cancer after radiation-based therapy[J]. J Obstet Gynaecol Res, 2021, 47(5): 1862-1870. DOI: 10.1111/jog.14712.
[33]
HUANG H P, LIU Q, ZHU L X, et al. Prognostic value of preoperative systemic immune-inflammation index in patients with cervical cancer[J/OL]. Sci Rep, 2019, 9(1): 3284 [2023-01-05]. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6397230. DOI: 10.1038/s41598-019-39150-0.
[34]
LIU P P, JIANG Y N, ZHENG X J, et al. Pretreatment systemic immune-inflammation index can predict response to neoadjuvant chemotherapy in cervical cancer at stages IB2-IIB[J/OL]. Pathol Oncol Res, 2022, 28: 1610294 [2023-01-05]. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9092215. DOI: 10.3389/pore.2022.1610294.
[35]
YANG L, XU Z Y, WANG Q, et al. Analysis of different prognostic effects of nadirs of neutrophils and lymphocytes during concurrent chemoradiotherapy for cervical cancer[J]. Chin J Radiat Oncol, 2021, 30(11): 1148-1153. DOI: 10.3760/cma.j.cn113030-20210329-00126.
[36]
ZHAO Y Y. Changes in peripheral blood cell parameters and evaluation of PNI in patients with cervical cancer undergoing concurrent chemoradiotherapy[D]. Jilin: Jilin Univ, 2022. DOI: 10.27162/d.cnki.gjlin.2022.005116.

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