5959 - Efficacy Evaluation of Optimal Patient Selection for Hypopharyngeal Cancer Organ Preservation Therapy using MRI-derived Radiomic Signature: Bi-institutional Propensity Score Matched Analysis

Background

Early loco-regional failure (LRF) after organ preservation therapy (OPT) varies widely for hypopharyngeal squamous cell carcinoma (HPSCC) patients. We aim to develop and validate a MRI-derived radiomic signature RS for the prediction of 1-year LRF in HPSCC treated with OPT, and investigate its efficacy between OPT and total laryngectomy (TL) cohort.

Methods

A total of 3912 MRI-based radiomic features (RF) of pretreatment tumors were obtained from 370 HPSCC patients, including OPT cohort1 (OPT1; n = 186), OPT cohort2 (OPT2; n = 88), and TL cohort (TLc; n = 96). Variational autoencoder (VAE), trained with symmetric two encoded and decoded layers of neural network was applied to reduce the dimensionality of original RF to 128 VAE-RF. Least absolute shrinkage and selection operator with 10-fold cross validation performs features selection and constructs RS to predict 1-year LRF events in OPT1, which was validated in OPT2 and TLC. Harrell’s C-index was used to evaluate the discriminative ability of RS. Optimal cut-point for dichotomized RS risk category was determined via Youden index. Pair-wise propensity score matching (caliper 0.2) using pre-treatment variables (age, gender, TNM stage) was applied to compare the impact of OPT and TL under different RS risk categories.

Results

The RS yielded 1000 times bootstrapping corrected C-index of 0.753, 0.745 and 0.398 in the OPT1, OPT2 and TLC, respectively. Dichotomized risk category using Youden cut-point of RS yielded 1 year LRF predictive accuracy of 71.12%, 70.41%, and 41.74% in OPT1, OPT2 and TLC, respectively. In RS-high risk group, OPT were associated with poor progression-free survival (PFS, HR: 1.752, p = 0.032), while in RS-low risk group, OPT did not deteriorate the PFS (HR: 0.774, p = 0.416).

Conclusions

The RS-based model provides a novel to predict 1-year LRF and survival in patients with HPSCC who received OPT. The prediction performance discrepancy of MRI-derived RS in TLC also emphasizes the role of TL in RS-high risk group.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.