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

Li, Lin; Shiradkar, Rakesh; Leo, Patrick; Algohary, Ahmad; Fu, Pingfu; Tirumani, Sree Harsha; Mahran, Amr; Buzzy, Christina; Obmann, Verena C.; Mansoori, Bahar; El-Fahmawi, Ayah; Shahait, Mohammed; Tewari, Ashutosh; Magi-Galluzzi, Cristina; Lee, David; Lal, Priti; Ponsky, Lee; Klein, Eric; Purysko, Andrei S. and Madabhushi, Anant (2021). A novel imaging based Nomogram for predicting post-surgical biochemical recurrence and adverse pathology of prostate cancer from pre-operative bi-parametric MRI. EBioMedicine, 63, p. 103163. Elsevier 10.1016/j.ebiom.2020.103163

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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.

Keywords: Adverse pathology; Biochemical recurrence; MRI; Prognosis; Prostate cancer; Radiomic.

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