Computed Tomography-based Radiomic Analysis for Prediction of Treatment Response to Salvage Chemoradiotherapy for Locoregional Lymph Node Recurrence After Curative Esophagectomy

Objective: To investigate the capability of computed tomography (CT) radiomic features to predict the therapeutic response and local control of the locoregional recurrence lymph node (LN) after curative esophagectomy by chemoradiotherapy.

Methods: This retrospective study included 129 LN from 77 patients (training cohort: 102 LN from 59 patients; validation cohort: 27 LN from 18 patients) with postoperative esophageal squamous cell carcinoma (ESCC). The region of the tumor was contoured in pretreatment contrast-enhanced CT images. The least absolute shrinkage and selection operator with logistic regression was used to identify radiomic predictors in the training cohort. Model performance was evaluated using the area under the receiver operating characteristic curves (AUC). The Kaplan-Meier method was used to determine the local recurrence time of cancer.

Results: The radiomic model suggested seven features that could be used to predict treatment response. The AUCs in training and validated cohorts were 0.777 (95% CI: 0.667-0.878) and 0.765 (95% CI: 0.556-0.975), respectively. A significant difference in the radiomic scores (Rad-scores) between response and nonresponse was observed in the two cohorts (p < 0.001, 0.034, respectively). Two features were identified for classifying whether there will be relapse in 2 years. AUC was 0.857 (95% CI: 0.780-0.935) in the training cohort. The local control time of the high Rad-score group was higher than the low group in both cohorts (p < 0.001 and 0.025, respectively). As inferred from the Cox regression analysis, the low Rad-score was a high-risk factor for local recurrence within 2 years.

Conclusions: The radiomic approach can be used as a potential imaging biomarker to predict treatment response and local control of recurrence LN in ESCC patients.