A multicenter study on the preoperative prediction of gastric cancer microsatellite instability status based on computed tomography radiomics

Abstract

Purpose: To construct and validate a radiomics feature model based on computed tomography (CT) images and clinical characteristics to predict the microsatellite instability (MSI) status of gastric cancer patients before surgery.

Methods: We retrospectively collected the upper abdominal or the entire abdominal-enhanced CT scans of 189 gastric cancer patients before surgery. The patients underwent postoperative gastric cancer MSI status testing, and the dates of their radiologic images and clinicopathological data were from January 2015 to August 2021. These 189 patients were divided into a training set (n = 90) and an external validation set (n = 99). The patients were divided by MSI status into the MSI-high (H) arm (30 and 33 patients in the training set and external validation set, respectively) and MSI-low/stable (L/S) arm (60 and 66 patients in the training set and external validation set, respectively). In the training set, the clinical characteristics and tumor radiologic characteristics of the patients were extracted, and the tenfold cross-validation method was used for internal validation of the training set. The external validation set was used to assess its generalized performance. A receiver-operating characteristic (ROC) curve was plotted to assess the model performance, and the area under the curve (AUC) was calculated.

Results: The AUC of the radiomics model in the training set and external validation set was 0.8228 [95% confidence interval (CI) 0.7355-0.9101] and 0.7603 [95% CI 0.6625-0.8581], respectively, showing that the constructed radiomics model exhibited satisfactory generalization capabilities. The accuracy, sensitivity, and specificity of the training dataset were 0.72, 0.63, and 0.77, respectively. The accuracy, sensitivity, and specificity of the external validation dataset were 0.67, 0.79, and 0.60, respectively. Statistical analysis was carried out on the clinical data, and there was statistical significance for the tumor site and age (p < 0.05). MSI-H gastric cancer was mostly seen in the gastric antrum and older patients.

Conclusions: Radiomics markers based on CT images and clinical characteristics have the potential to be a non-invasive auxiliary diagnostic tool for preoperative assessment of gastric cancer MSI status, and they can aid in clinical decision-making and improve patient outcomes.

Keywords: CT; Gastric cancer; Microsatellite instability; Radiomics.