A novel imaging based Nomogram for predicting post-surgical biochemical recurrence and adverse pathology of prostate cancer from pre-operative bi-parametric MRI

• Main Authors: Lin Li, Rakesh Shiradkar, Patrick Leo, Ahmad Algohary, Pingfu Fu, Sree Harsha Tirumani, Amr Mahran, Christina Buzzy, Verena C Obmann, Bahar Mansoori, Ayah El-Fahmawi, Mohammed Shahait, Ashutosh Tewari, Cristina Magi-Galluzzi, David Lee, Priti Lal, Lee Ponsky, Eric Klein, Andrei S. Purysko, Anant Madabhushi
• Format: Article
• Language: English
• Published: Elsevier 2021-01-01
• Series: EBioMedicine
• Subjects: Prostate cancer; Biochemical recurrence; Adverse pathology; Radiomic; MRI; Prognosis
• Online Access: http://www.sciencedirect.com/science/article/pii/S2352396420305399

Background: We developed and validated an integrated radiomic-clinicopathologic nomogram (RadClip) for post-surgical biochemical recurrence free survival (bRFS) and adverse pathology (AP) prediction in men with prostate cancer (PCa). RadClip was further compared against extant prognostics tools like CAPRA and Decipher. Methods: A retrospective study of 198 patients with PCa from four institutions who underwent pre-operative 3 Tesla MRI followed by radical prostatectomy, between 2009 and 2017 with a median 35-month follow-up was performed. Radiomic features were extracted from prostate cancer regions on bi-parametric magnetic resonance imaging (bpMRI). Cox Proportional-Hazards (CPH) model warped with minimum redundancy maximum relevance (MRMR) feature selection was employed to select bpMRI radiomic features for bRFS prediction in the training set (D1, N = 71). In addition, a bpMRI radiomic risk score (RadS) and associated nomogram, RadClip, were constructed in D1 and then compared against the Decipher, pre-operative (CAPRA), and post-operative (CAPRA-S) nomograms for bRFS and AP prediction in the testing set (D2, N = 127). Findings: “RadClip yielded a higher C-index (0.77, 95% CI 0.65-0.88) compared to CAPRA (0.68, 95% CI 0.57-0.8) and Decipher (0.51, 95% CI 0.33-0.69) and was found to be comparable to CAPRA-S (0.75, 95% CI 0.65-0.85). RadClip resulted in a higher AUC (0.71, 95% CI 0.62-0.81) for predicting AP compared to Decipher (0.66, 95% CI 0.56-0.77) and CAPRA (0.69, 95% CI 0.59-0.79).” Interpretation: RadClip was more prognostic of bRFS and AP compared to Decipher and CAPRA. It could help pre-operatively identify PCa patients at low risk of biochemical recurrence and AP and who therefore might defer additional therapy. Funding: The National Institutes of Health, the U.S. Department of Veterans Affairs, and the Department of Defense.