Improving Treatment Response Prediction for Chemoradiation Therapy of Pancreatic Cancer Using a Combination of Delta-Radiomics and the Clinical Biomarker CA19-9
Improving Treatment Response Prediction for Chemoradiation Therapy of Pancreatic Cancer Using a Combination of Delta-Radiomics and the Clinical Biomarker CA19-9
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Recently we showed that delta radiomics features (DRF) from daily CT-guided chemoradiation therapy (CRT) is associated with early prediction of treatment response for pancreatic cancer.CA19-9 is a widely used clinical biomarker for pancreatic cancer.The purpose of this work is to investigate if the predictive power of such biomarkers (DRF or CA19-9) can improve by iphone 13 price dallas combining both biomarkers.Daily non-contrast CTs acquired during routine CT-guided neoadjuvant CRT for 24 patients (672 datasets, in 28 daily fractions), along with their CA19-9, pathology reports and follow-up data were analyzed.
The pancreatic head was segmented on each daily CT and radiomic features were extracted from the segmented regions.The time between the end of treatment and last follow-up was used to build a survival model.Patients were divided into two groups based on their pathological response.Spearman correlations were used to find the DRFs correlated to CA19-9.
A regression model was built to examine the effect of combining CA19-9 and DRFs on response prediction.C-index was used to measure model effectiveness.The effect of a decrease in CA19-9 levels during treatment vs.failure of CA19-9 levels to normalize on survival was examined.
Univariate- and multivariate Cox-regression analysis were performed to determine the effect of combining CA19-9 and DRFs on survival correlations.Spearman correlation showed that CA19-9 is correlated to DRFs (Entropy, cluster tendency and coarseness).An Increase in CA19-9 levels during treatment were correlated to a bad response, while a decline was correlated to a good response.Incorporating CA19-9 with DRFs increased the c-index from 0.
57 to 0.87 indicating a stronger model.The univariate analysis showed that patients with decreasing CA19-9 had an improved median survival (68 months) compared to those with increasing levels (33 months).The 5-years survival was improved for the decreasing CA19-9 group (55%) compared to the increasing group (30%).
The Cox-multivariate analysis showed that treatment related decrease in CA19-9 levels (p = 0.031) and DRFs (p = 0.001) were predictors of survival.The hazard-ratio was reduced from 0.
73, p = 0.032 using CA19-9 only to 0.58, p = 0.028 turbosound ts-18sw700/8a combining DRFs with CA19-9.
DRFs-CA19-9 combination has the potential to increasing the possibility for response-based treatment adaptation.