Affiliation:
1. Department of Urology The First Affiliated Hospital Jiangxi Medical College Nanchang University Nanchang Jiangxi China
2. Jiangxi Provincial Key Laboratory of Urinary System Diseases Nanchang China
3. Department of Computer Science Columbia University New York New York USA
4. Medical College of Nanchang University Nanchang University Nanchang China
5. Department of Nuclear Medicine Jiangxi Provincial People's Hospital The First Affiliated Hospital of Nanchang Medical College Nanchang China
6. R&D Yizhun Medical AI Beijing China
7. Department of Radiology Jiangxi Provincial People's Hospital The First Affiliated Hospital of Nanchang Medical College Nanchang China
8. Department of Quality Control The First Affiliated Hospital Jiangxi Medical College Nanchang University Nanchang Jiangxi China
Abstract
AbstractBackgroundPredicting the accurate preoperative staging of bladder cancer (BLCA), which markedly affects treatment decisions and patient outcomes, using traditional clinical parameters is challenging. Nevertheless, emerging studies in radiomics, especially machine learning‐based computed tomography (CT) image‐based radiomics, hold promise in improving stage prediction accuracy in various tumors. However, the comparative performance and clinical utility of models for BLCA are under investigation.PurposeWe aimed to investigate the application value of machine learning‐based CT radiomics in preoperative staging prediction by comparing the performance of clinical, radiomics, and clinical–radiomics combined models.MethodsA retrospective cohort of 105 patients with initial BLCA was randomized into training (70%) and testing (30%) cohorts. Radiomics features were extracted from CT images using the optimal feature filter, followed by the application of the least absolute shrinkage and selection operator algorithm for optimum feature selection. Furthermore, machine learning algorithms were used to establish a radiomics model within the training cohort. Independent risk factors for muscle‐invasive BLCA (MIBC) obtained by multivariate logistic regression (LR) analysis were separately used to construct a clinical model. For a clinical–radiomics fusion model, radiomics features were combined with clinical parameters. Performance was evaluated based on receiver operating characteristic curves, calibration curves, decision curve analysis (DCA), and standard performance metrics.ResultsPatients exhibited a significantly higher age (p = 0.029), larger tumor size (p = 0.01), and an increased neutrophil‐to‐lymphocyte ratio (NLR; p = 0.045) in the MIBC group than in the NMIBC group. LR analysis revealed age (p = 0.026), tumor size (p = 0.007), and NLR (p = 0.019) as significant predictors for constructing the clinical model. In the testing cohort, the radiomics model, which used an Support Vector Machine classifier, achieved the highest area under the curve (AUC) value of 0.857. The clinical–radiomics model outperformed the remaining two models, with AUC values of 0.958 and 0.893 in the training and testing cohorts, respectively. DeLong's test indicated significant differences between the three models. Calibration curves showed good agreement, and DCA confirmed the superior clinical utility of the clinical–radiomics model.ConclusionsMachine learning‐based CT radiomics combined with clinical parameters was a promising approach in staging BLCA accurately, which outperformed the individual models. Integrating radiomics features with clinical information holds the potential to improve personalized treatment planning and patient outcomes in BLCA.