Prognostic impact of pelvic bone magnetic resonance imaging features in patients with cervical cancer undergoing definitive concurrent chemoradiotherapy.
Authors
Affiliations (2)
Affiliations (2)
- Ajou University of Medicine, Department of Radiation Oncology, Suwon, South Korea; Moffitt Cancer Center, Department of Machine Learning, Tampa, FL, USA. Electronic address: [email protected].
- Moffitt Cancer Center, Department of Machine Learning, Tampa, FL, USA.
Abstract
To determine whether pre-treatment pelvic bone T1-weighted magnetic resonance imaging provides additional prognostic information beyond traditional clinical variables in patients with cervical cancer undergoing definitive concurrent chemoradiotherapy. We retrospectively analyzed 494 treatment-naive patients with cervical cancer who underwent pre-treatment magnetic resonance imaging prior to chemoradiotherapy. Pelvic bone-masked images were processed using a vision transformer framework. A stability-driven feature selection process across repeated Monte Carlo splits and pre-processing configurations identified 2 highly reproducible imaging biomarkers. Survival models were developed using overall survival as the primary endpoint. External validation was performed in 38 patients from The Cancer Genome Atlas without refitting imaging features. The feature-extraction architecture with the highest mean external concordance index was selected, and a representative model was used for clinically interpretable survival analyses. Model-derived 60-month predicted mortality risk was analyzed as a continuous variable in multi-variable Cox proportional hazards models and used for Kaplan-Meier risk stratification. In the discovery cohort, the image-only model achieved a mean concordance index of 0.84 (95% confidence interval 0.82 to 0.85) for overall survival, exceeding that of the clinical-only model (0.52). Imaging-derived risk significantly stratified overall survival in Kaplan-Meier analyses. Five-year overall survival was lower in the high imaging risk group compared with the low imaging risk group within both IB to IIIC1 (69.8% vs 95.4%) and IIIC2 to IVB (47.2% vs 93.7%) stage categories (p <.001 for both). In multi-variable Cox analyses adjusted for age, stage, and histology, imaging-derived risk remained independently associated with overall survival (hazard ratio 1.72 per 10% increase, 95% confidence interval 1.60 to 1.85, p <.001). External validation demonstrated consistent overall survival discrimination (mean concordance index = 0.74). Pre-treatment pelvic bone magnetic resonance imaging captures reproducible host-related imaging signatures derived from marrow-containing pelvic bone regions that are associated with overall survival and refine conventional stage-based risk stratification in patients with cervical cancer undergoing chemoradiotherapy.