Preoperative prediction of recurrence risk factors in operable cervical cancer based on clinical-radiomics features

Objective: To investigate the value of preoperative prediction of risk factors for recurrence of operable cervical cancer based on the radiomics features of biparametric magnetic resonance imaging (bp-MRI) combined with clinical features. Method: A retrospective collection of cervical cancer cases undergoing radical hysterectomy + pelvic and/or para-aortic lymph node dissection at the Affiliated Hospital of North Sichuan Medical College was conducted. Region of interest (ROI) was outlined using the 3D Slicer software, and radiomics after feature extraction and feature screening was performed using the least absolute shrinkage and selection operator (LASSO) algorithm. Logistic regression algorithms were used to construct a fusion clinical-radiomics model to visualize nomograms. Receiver operating characteristic (ROC), DeLong test, calibration curve (CC), and decision curve (DC) were used to evaluate the predictive performance and clinical benefit of the model. Result: A total of 99 patients with cervical cancer were included in this study, with 79 and 20 cases in the training and test groups, respectively. Seventeen key features were selected for radiomics model construction. Three clinical features were screened to construct a clinical model. A fusion model of the radiomics model combined with the clinical model was constructed. The area under the curve (AUC) values in the training group were 0.710 (95% CI 0.602-0.819), 0.892 (95% CI 0.826-0.958), and 0.906 (95% CI 0.842-0.970), for the comparative clinical model, radiomics model, and fusion model, respectively, and the AUC values in the testing group were 0.620 (95% CI 0.366-0.874), 0.860 (95% CI 0.677-1.000), and 0.880 (95% CI 0.690-1.000), respectively. The DeLong test showed a statistically significant difference between the AUC values of the fusion model and the clinical model (p < 0.05). Decision curve analysis (DCA) showed that the fusion model had the greatest net benefit when the threshold probability was approximately 0.5. Conclusion: The fusion model constructed based on bp-MRI radiomics features combined with clinical features provides an important reference for predicting the risk status of recurrence in operable cervical cancer. The findings of this study are preliminary exploratory results, and further large-scale, multicenter studies are needed to validate these findings.