Evaluation Of Prognostic Effect Of Radiomics Based On Multi-modal Magnetic Resonance Imaging For Extranodal Nasal-type NK/T-cell Lymphoma Of The Upper Aerodigestive Tract

Part ?:Evaluation of prognostic effect of radiomics based on multi-modal magnetic resonance imaging for extranodal nasal-type NK/T-cell lymphoma of the upper aerodigestive tractPurpose:To develop a radiomics signature based on multi-modal magnetic resonance imaging(MRI)of the head and neck for estimating overall survival(OS)in patients with extranodal nasal-type NK/T-cell lymphoma(ENKTCL)of the upper aerodigestive tract(UADT)and to establish a radiomics-based model that incorporates the radiomics signature and clinical findings.Patients and Methods:We identified 176 patients with UADT ENKTCL who underwent MRI of the head and neck before treatment.An unsupervised spectral clustering method was used to identify groups of patients and radiomic features.The OS was compared between two groups.Multivariate Cox proportional hazards model and Spearman rank correlation analysis were used to determine the association of the radiomics signature with OS and clinical factors.A combined radiomics-based model(nomogram-revised risk index plus multi-modal magnetic resonance imaging radiomics signature,NRI-M)was developed by incorporating the radiomics signature with nomogram-revised risk index(NRI).The radiomics signature and combined radiomics-based model were internally validated and compared with NRI by examining discrimination,calibration,and decision curve.Results:Differences in OS were found between 2 groups of the developed radiomics signature.The 5-? OS rates between the two groups were 87.2%vs.67.3%(P=0.002)in all patients and 88.8%vs.69.2%(P=0.003)in early-stage patients.A significant correlation was observed between the radiomics signature and primary tumor invasion.The area under the curve(AUC),Harrell's C index,absolute net reclassification index and integrated Brier score of NRI-M were 0.748,0.740,13.07%,and 0.142,respectively,for all patients,and 0.717,0.729,13.86%,and 0.140,respectively,for early-stage patients.Compared with either radiomics signature or NRI,NRI-M showed the best discrimination and calibration.Moreover,NRI-M improved net reclassification index than NRI.Decision curve analysis of the NRI-M also showed a good outcome.Conclusions:The NRI-M model derived from radiomics signature and clinical factors has good performance for predicting the prognosis in UADT ENKTCL and may help to design clinical trials and improve clinical decision making.Part ?:Clinical features and treatment outcome of extranodal nasal-type NK/T-cell lymphoma of the extra-upper aerodigestive tractPurpose:To investigate the clinical features and prognosis of extranodal nasal-type NK/T-cell lymphoma(ENKTCL)of the extra-upper aerodigestive tract(extra-UADT ENKTCL).Patients and Methods:A total of 159 patients with extra-UADT ENKTCL from the China Lymphoma Collaborative Group(CLCG)database between November 2001 and December 2015 were retrospectively analyzed.One hundred and three patients received chemotherapy alone,whereas 56 patients received radiotherapy/surgery with or without chemotherapy.Kaplan-Meier survival analyses and Logrank test were used to calculate actuarial survival.Results:Extra-UADT ENKTCL commonly occurs in skin and soft tissues(66.7%)and the gastrointestinal tract(19.5%).According to the Ann Arbor staging system,102(64.2%)patients had advanced-stage disease.Elevated lactate dehydrogenase(LDH)level was observed in 47.8%of patients.The 3-year overall survival(OS)and progression-free survival(PFS)rates were 43.6%and 27.9%,respectively.The corresponding OS and PFS rates were 41.0%and 24.8%for primary skin/soft tissue sites,and 59.4%(P=0.281)and 48.3%(P=0.109)for primary gastrointestinal tract sites,respectively.For all patients,combined modality treatment improved the 3-year OS(58.4%vs 33.9%,P=0.001)and 3-year PFS(40.7%vs 20.7%,P=0.008),compared with chemotherapy alone.For the 57 patients with stage ? and ? diseases,the 3-year OS and PFS rates,respectively,were 69.4%and 43.8%for radiotherapy ±chemotherapy,compared with 63.0%(P=0.099)and 43.2%(P=0.277)for chemotherapy alone.No significant differences between two treatment groups may be due to the small sample of patients.The distant extranodal dissemination was the primary failure patterns.Conclusions:Extra-UADT ENKTCL appears to have distinct clinical characteristics and poor outcomes.Compared with chemotherapy alone,combined modality treatment may improve the prognosis of patients with extra-UADT ENKTCL.