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• Clinical Article •
Nomogram based on clinical, pathological, and DWI quantitative parameters for predicting the programmed death-ligand 1 positive expression in cervical cancer: Comparison of different ROI options
LIU Kaihui  YANG Wei  TIAN Haiping  ZHANG Zhining  LI Yunxia  HE Jianli 

Cite this article as: LIU K H, YANG W, TIAN H P, et al. Nomogram based on clinical, pathological, and DWI quantitative parameters for predicting the programmed death-ligand 1 positive expression in cervical cancer: Comparison of different ROI options[J]. Chin J Magn Reson Imaging, 2023, 14(10): 98-104, 115. DOI:10.12015/issn.1674-8034.2023.10.017.


[Abstract] Objective To explore the value of the nomogram based on clinical, pathological, and diffusion weighted imaging (DWI) quantitative parameters for predicting programmed death-ligand 1 (PD-L1) positive expression in cervical cancer.Materials and Methods A total of 683 patients with pathologically confirmed cervical cancer between January 2018 to June 2020 were retrospectively enrolled as the training cohort. They underwent pelvic MRI scans and PD-L1 immunohistochemical staining. The solid component of tumors on DWI images was identified using T2WI and enhanced images. The region of interest (ROI) was manually drawn around the tumor borders, and apparent diffusion coefficient (ADC) values were obtained from corresponding ADC pseudo-color images. The mean ADC value (ADCmean) was calculated by averaging ADC values from selected slices. Additionally, the maximum solid component slice on DWI was chosen, and the ADC value for this slice was recorded as single section ADC (ADCss). For each slice containing solid tumor components, multiple circular or circular-like ROIs (30-50 mm²) were placed to extract minimum ADC (ADCmin) values. Differences in clinical, pathological, and imaging parameters including age at diagnosis, FIGO staging, pathological grade, parametrial invasion, lymph node status, and ADC values from different ROIs were compared between PD-L1 positive and negative groups. Univariable and multivariable logistic regression analyses were conducted to identify independent parameters related to PD-L1 positive expression. Clinical-pathological and combined clinical-pathological-imaging models were developed. Diagnostic effectiveness of different ADC values and models was assessed using area under the curve (AUC) of receiver operating characteristic (ROC) and DeLong test. The combined model's nomogram, calibration slope, and decision curve were evaluated. A validation cohort of 332 cervical cancer patients from July 2020 to December 2022 was enrolled to validate the nomogram.Results FIGO staging, pathological grade, parametrial invasion, lymph node status, ADCmean, ADCss, ADCmin were independently correlated with PD-L1 expression (all P＜0.05). Among three ADC values, ADCmin demonstrated the highest diagnostic efficacy with an AUC of 0.882 (95% CI: 0.855-0.905). The combined nomogram, incorporating ADCmin, clinical, and pathological factors, performed well in both the training and validation cohorts, yielding AUC of 0.906 (95% CI: 0.882-0.927) and 0.903 (95% CI: 0.866-0.933) respectively. Calibration curves indicated good fit of the nomogram. Decision curve analysis showed the nomogram's higher net benefit compared to the clinicopathological model.Conclusions The nomogram, utilizing clinical, pathological, and ADCmin data, effectively predicted PD-L1 expression in cervical cancer.
[Keywords] uterine cervical neoplasms；magnetic resonance imaging；diffusion weighted imaging；immunotherapy；programmed death-ligand 1；ligand

LIU Kaihui1   YANG Wei2*   TIAN Haiping3   ZHANG Zhining4   LI Yunxia5   HE Jianli6  

1 College of Clinical Medicine, Ningxia Medical University, Yinchuan 750004, China

2 Department of Radiology, General Hospital of Ningxia Medical University, Yinchuan 750004, China

3 Department of Pathology, General Hospital of Ningxia Medical University, Yinchuan 750004, China

4 Department of Gynecological Oncology, General Hospital of Ningxia Medical University, Yinchuan 750004, China

5 Department of Medical Oncology, General Hospital of Ningxia Medical University, Yinchuan 750004, China

6 Department of Radiotherapy, General Hospital of Ningxia Medical University, Yinchuan 750004, China

Corresponding author: YANG W, E-mail: yangwei_0521@163.com

Conflicts of interest   None.

ACKNOWLEDGMENTS National Natural Science Foundation of China Project (No. 81860302).
Received  2023-05-24
Accepted  2023-09-22
DOI: 10.12015/issn.1674-8034.2023.10.017
Cite this article as: LIU K H, YANG W, TIAN H P, et al. Nomogram based on clinical, pathological, and DWI quantitative parameters for predicting the programmed death-ligand 1 positive expression in cervical cancer: Comparison of different ROI options[J]. Chin J Magn Reson Imaging, 2023, 14(10): 98-104, 115. DOI:10.12015/issn.1674-8034.2023.10.017.

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