The Usefulness of Machine Learning-Based Evaluation of Clinical and Pretreatment [ 18 F]-FDG-PET/CT Radiomic Features for Predicting Prognosis in Hypopharyngeal Cancer.

Purpose: To examine whether the machine learning (ML) analyses using clinical and pretreatment 2-deoxy-2-[ ¹⁸ F]fluoro-D-glucose positron emission tomography ([ ¹⁸ F]-FDG-PET)-based radiomic features were useful for predicting prognosis in patients with hypopharyngeal cancer.
Procedures: This retrospective study included 100 patients with hypopharyngeal cancer who underwent [ ¹⁸ F]-FDG-PET/X-ray computed tomography (CT) before treatment, and these patients were allocated to the training (n=80) and validation (n=20) cohorts. Eight clinical (age, sex, histology, T stage, N stage, M stage, UICC stage, and treatment) and 40 [ ¹⁸ F]-FDG-PET-based radiomic features were used to predict disease progression. A feature reduction procedure based on the decrease of the Gini impurity was applied. Six ML algorithms (random forest, neural network, k-nearest neighbors, naïve Bayes, logistic regression, and support vector machine) were compared using the area under the receiver operating characteristic curve (AUC). Progression-free survival (PFS) was assessed using Cox regression analysis.
Results: The five most important features for predicting disease progression were UICC stage, N stage, gray level co-occurrence matrix entropy (GLCM&#95;Entropy), gray level run length matrix run length non-uniformity (GLRLM&#95;RLNU), and T stage. Patients who experienced disease progression displayed significantly higher UICC stage, N stage, GLCM&#95;Entropy, GLRLM&#95;RLNU, and T stage than those without progression (each, p<0.001). In both cohorts, the logistic regression model constructed by these 5 features was the best performing classifier (training: AUC=0.860, accuracy=0.800; validation: AUC=0.803, accuracy=0.700). In the logistic regression model, 5-year PFS was significantly higher in patients with predicted non-progression than those with predicted progression (75.8% vs. 8.3%, p<0.001), and this model was only the independent factor for PFS in multivariate analysis (hazard ratio = 3.22; 95% confidence interval = 1.03-10.11; p=0.045).
Conclusions: The logistic regression model constructed by UICC, T and N stages and pretreatment [ ¹⁸ F]-FDG-PET-based radiomic features, GLCM&#95;Entropy, and GLRLM&#95;RLNU may be the most important predictor of prognosis in patients with hypopharyngeal cancer.
(© 2022. The Author(s), under exclusive licence to World Molecular Imaging Society.)