用PET/CT图像和时间信息预测肺癌患者生存期,提升预后评估精度。
Time-driven Survival Analysis from FDG-PET/CT in Non-Small Cell Lung Cancer
- 融合影像嵌入与时间变量的深度回归模型,实现随时间变化的生存率预测。
- 相比仅用图像的基线方法,AUC提升4.3%,最佳模型性能达0.788。
- 可区分高低风险患者,且热力图揭示肿瘤区域是关键预测依据。
目的:基于医学影像的自动化临床结局预测(如总生存期)在改善患者预后和个性化治疗方面具有巨大潜力。本文提出一种深度回归框架,以组织级FDG-PET/CT投影为输入,并引入表示时间跨度(单位:天)的标量时间变量,用于预测非小细胞肺癌(NSCLC)患者的总生存期(OS)。方法:框架采用ResNet-50主干网络处理输入图像并生成图像嵌入,再将嵌入与时间数据结合,生成随时间变化的生存概率,实现时间参数化预测。模型基于U-CAN队列(n = 556)训练,并在测试集(n = 292)上与仅使用图像的基线方法进行比较。该基线方法也使用ResNet-50,但仅提供预设时间点(如2年或5年)的生存预测。结果:引入时间变量后,模型在生存预测上表现更优,相较基线方法提升AUC 4.3%。结合影像与临床+IDP特征的模型表现优异,而影像与临床+IDP模型的集成达到最佳性能(AUC 0.788),凸显多模态输入的互补价值。模型还能有效对患者进行风险分层(高风险与低风险)。显著性分析热图显示肿瘤区域是主要预测依据。结论:本方法构建了一个自动化的时变生存预测框架,验证了影像与表格数据融合在生存预测中的潜力。
原文摘要 · Abstract (English)
Purpose: Automated medical image-based prediction of clinical outcomes, such as overall survival (OS), has great potential in improving patient prognostics and personalized treatment planning. We developed a deep regression framework using tissue-wise FDG-PET/CT projections as input, along with a temporal input representing a scalar time horizon (in days) to predict OS in patients with Non-Small Cell Lung Cancer (NSCLC). Methods: The proposed framework employed a ResNet-50 backbone to process input images and generate corresponding image embeddings. The embeddings were then combined with temporal data to produce OS probabilities as a function of time, effectively parameterizing the predictions based on time. The overall framework was developed using the U-CAN cohort (n = 556) and evaluated by comparing with a baseline method on the test set (n = 292). The baseline utilized the ResNet-50 architecture, processing only the images as input and providing OS predictions at pre-specified intervals, such as 2- or 5-year. Results: The incorporation of temporal data with image embeddings demonstrated an advantage in predicting OS, outperforming the baseline method with an improvement in AUC of 4.3%. The proposed model using clinical + IDP features achieved strong performance, and an ensemble of imaging and clinical + IDP models achieved the best overall performance (0.788), highlighting the complementary value of multimodal inputs. The proposed method also enabled risk stratification of patients into distinct categories (high vs low risk). Heat maps from the saliency analysis highlighted tumor regions as key structures for the prediction. Conclusion: Our method provided an automated framework for predicting OS as a function of time and demonstrates the potential of combining imaging and tabular data for improved survival prediction.
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