Computed Tomography-based Radiomics Nomogram for the Preoperative Prediction of Tumor Deposits and Clinical Outcomes in Colon Cancer: a Multicenter Study

Rationale and Objectives: To develop and validate a computed tomography (CT)-based radiomics nomogram for the preoperative prediction of tumor deposits (TDs) and clinical outcomes in patients with colon cancer. Materials and Methods: This retrospective study included 383 consecutive patients with colon cancer from two centers. Radiomics features were extracted from portal venous phase CT images. Least absolute shrinkage and selection operator regression was applied for feature selection and radiomics signature construction. The multivariate logistic regression model was used to establish a radiomics nomogram. The performance of the nomogram was assessed by using receiver operating characteristic curves, calibration curves and decision curve analysis. Kaplan-Meier survival analysis was used to assess the difference of the overall survival (OS) in the TDs-positive Results: The radiomics signature was composed of 11 TDs status related features. The AUCs of the radiomics model in the training cohort, internal validation and external validation cohorts were 0.82, 0.78 and 0.78, respectively. The radiomics nomogram that incorporated the radiomics signature and clinical independent predictors (CT-N, CEA and CA199) showed good calibration and discrimination with AUCs of 0.88, 0.80 and 0.81 in the training cohort, internal validation and external validation cohorts, respectively. The radiomics nomogram-predicted high-risk groups had a worse OS than the low-risk groups (p < 0.001). The radiomics nomogram-predicted TDs was an independent preoperative predictor of OS. Conclusion: The radiomics nomogram based on CT radiomics features and clinical independent predictors could effectively predict the preoperative TDs status and OS of colon cancer. Important Findings: CT-based radiomics nomogram may be applied in the individual preoperative prediction of TDs status in colon cancer. Additionally, there was a significant difference in OS between the high-risk and low-risk groups defined by the radiomics nomogram, in which patients with high-risk TDs had a significantly worse OS, compared with those with low-risk TDs.