A systematic review and meta-analysis of predictive and prognostic models for outcome prediction using positron emission tomography radiomics in head and neck squamous cell carcinoma patients

Abstract

Background: Positron emission tomography (PET) images of head and neck squamous cell carcinoma (HNSCC) patients can assess the functional and biochemical processes at cellular levels. Therefore, PET radiomics-based prediction and prognostic models have the potentials to understand tumour heterogeneity and assist clinicians with diagnosis, prognosis and management of the disease. We conducted a systematic review of published modelling information to evaluate the usefulness of PET radiomics in the prediction and prognosis of HNSCC patients.

Methods: We searched bibliographic databases (MEDLINE, Embase, Web of Science) from 2010 to 2021 and considered 31 studies with pre-defined inclusion criteria. We followed the CHARMS checklist for data extraction and performed quality assessment using the PROBAST tool. We conducted a meta-analysis to estimate the accuracy of the prediction and prognostic models using the diagnostic odds ratio (DOR) and average C-statistic, respectively.

Results: Manual segmentation method followed by 40% of the maximum standardised uptake value (SUV_max ) thresholding is a commonly used approach. The area under the receiver operating curves of externally validated prediction models ranged between 0.60-0.87, 0.65-0.86 and 0.62-0.75 for overall survival, distant metastasis and recurrence, respectively. Most studies highlighted an overall high risk of bias (outcome definition, statistical methodologies and external validation of models) and high unclear concern in terms of applicability. The meta-analysis showed the estimated pooled DOR of 6.75 (95% CI: 4.45, 10.23) for prediction models and the C-statistic of 0.71 (95% CI: 0.67, 0.74) for prognostic models.

Conclusions: Both prediction and prognostic models using clinical variables and PET radiomics demonstrated reliable accuracy for detecting adverse outcomes in HNSCC, suggesting the prospect of PET radiomics in clinical settings for diagnosis, prognosis and management of HNSCC patients. Future studies of prediction and prognostic models should emphasise the quality of reporting, external model validation, generalisability to real clinical scenarios and enhanced reproducibility of results.

Keywords: head and neck squamous cell carcinoma; positron emission tomography; prognosis; radiomics; systematic review.

FIGURE 1

Flow diagram highlighting search strategy and selection of studies.

FIGURE 2

Quality assessment using PROBAST for (A) the overall risk of bias at participants, predictors, outcome and analysis levels and the overall pooled data; (B) the overall applicability of the included studies at participants, predictors and outcome levels and the overall pooled data.

FIGURE 3

(A) Forest plot of the summary estimate of logarithmic DOR and the corresponding 95% confidence interval (CI) of prediction models (Performance metrics were based on external validation except for Ghosh et al. and Peng et al., where the performance metrics were based on internal validation). (B) Forest plot of pooled C‐statistic and the corresponding 95% CI of prognostic models (Performance metrics were based on internal validation except for Bogowicz et al., Lv et al., Martens et al. and Vallières et al., where the performance metrics were based on external validation).