Potential Value of Radiomics in the Identification of Stage T3 and T4a Esophagogastric Junction Adenocarcinoma Based on Contrast-Enhanced CT Images

Purpose This study was designed to evaluate the predictive performance of contrast-enhanced CT-based radiomic features for the personalized, differential diagnosis of esophagogastric junction (EGJ) adenocarcinoma at stages T3 and T4a. Methods Two hundred patients with T3 (n = 44) and T4a (n = 156) EGJ adenocarcinoma lesions were enrolled in this study. Traditional computed tomography (CT) features were obtained from contrast-enhanced CT images, and the traditional model was constructed using a multivariate logistic regression analysis. A radiomic model was established based on radiomic features from venous CT images, and the radiomic score (Radscore) of each patient was calculated. A combined nomogram diagnostic model was constructed based on Radscores and traditional features. The diagnostic performances of these three models (traditional model, radiomic model, and nomogram) were assessed with receiver operating characteristics curves. Sensitivity, specificity, accuracy, positive predictive value, negative predictive value, and areas under the curve (AUC) of models were calculated, and the performances of the models were evaluated and compared. Finally, the clinical effectiveness of the three models was evaluated by conducting a decision curve analysis (DCA). Results An eleven-feature combined radiomic signature and two traditional CT features were constructed as the radiomic and traditional feature models, respectively. The Radscore was significantly different between patients with stage T3 and T4a EGJ adenocarcinoma. The combined nomogram performed the best and has potential clinical usefulness. Conclusions The developed combined nomogram might be useful in differentiating T3 and T4a stages of EGJ adenocarcinoma and may facilitate the decision-making process for the treatment of T3 and T4a EGJ adenocarcinoma.