Prediction of 5-year Progression-Free Survival in Advanced Nasopharyngeal Carcinoma with Pretreatment PET/CT using Multi-Modality Deep Learning-based Radiomics

Objective: Deep Learning-based Radiomics (DLR) has achieved great success in medical image analysis and has been considered a replacement for conventional radiomics that relies on handcrafted features. In this study, we aimed to explore the capability of DLR for the prediction of 5-year Progression-Free Survival (PFS) in Nasopharyngeal Carcinoma (NPC) using pretreatment PET/CT. Methods: A total of 257 patients (170/87 in internal/external cohorts) with advanced NPC (TNM stage III or IVa) were enrolled. We developed an end-to-end multi-modality DLR model, in which a 3D convolutional neural network was optimized to extract deep features from pretreatment PET/CT images and predict the probability of 5-year PFS. TNM stage, as a high-level clinical feature, could be integrated into our DLR model to further improve the prognostic performance. To compare conventional radiomics and DLR, 1456 handcrafted features were extracted, and optimal conventional radiomics methods were selected from 54 cross-combinations of 6 feature selection methods and 9 classification methods. In addition, risk group stratification was performed with clinical signature, conventional radiomics signature, and DLR signature. Results: Our multi-modality DLR model using both PET and CT achieved higher prognostic performance than the optimal conventional radiomics method. Furthermore, the multi-modality DLR model outperformed single-modality DLR models using only PET or only CT. For risk group stratification, the conventional radiomics signature and DLR signature enabled significant differences between the high- and low-risk patient groups in both internal and external cohorts, while the clinical signature failed in the external cohort. Conclusion: Our study identified potential prognostic tools for survival prediction in advanced NPC, suggesting that DLR could provide complementary values to the current TNM staging.