Construction and Validation of a MRI‑Based Radiomic Nomogram to Predict Overall Survival in Patients with Local Advanced Cervical Cancer: A Multicenter Study.

Background: Cervical cancer is the fourth most common cancer among women. Radiomics has emerged as a new approach providing valuable information for cancer management. The aim of this study was to construct a radiomics nomogram to accurately predict survival outcomes in patients with locally advanced cervical cancer.

Methods: This retrospective study enrolled a total of 582 locally advanced cervical cancer patients from three center (training cohort: n = 228; internal validation cohort: n = 98; external validation cohort: n = 256). Radiomic features were extracted from pretreatment MRI images. Least absolute shrinkage and selection operator logistic regression were applied to select radiomic features and calculated the radiomic scores. Univariate and multivariate Cox proportional hazards regression analyses were used to identify the independent prognostic clinic-radiological factors for cervical cancer, which were incorporated into the nomogram.

Results: A total of six radiomic features were found to be associated with overall survival (OS) of locally advanced cervical cancer patients. The AUC of radiomic scores in the training cohort was 0.634-0.708 for the training cohort, 0.725-0.762 for internal validation cohort and 0.788-0.881 for the external validation cohort. Age, parametrial invasion, and radiomic score were the independent prognostic indicators for cervical cancer patients (Age: HR=1.041, 95% CI=1.012-1.071, p = 0.006; Parametrial invasion: HR=4.755, 95% CI=1.493-15.144, p = 0.008; HR=2.324, 95% CI=1.050-5.143, p = 0.037). The nomogram model incorporating these factors showed favorable discrimination in predicting the overall survival rates of cervical cancer patients, with the AUC values of 0.809, 0.808, and 0.862 for 1-, 2-, and 3-year predictions. The decision curve analysis (DCA) indicated that the nomogram model achieved the highest clinical net benefit across the entire range of reasonable threshold probabilities.

Conclusion: The nomogram, incorporating clinicopathological factors and radiomic features derived from MRI images, showed satisfactory discrimination in predicting the OS rates of locally advanced cervical cancer patients.