Background Personalized therapy planning remains a significant challenge in advanced colorectal cancer care, despite extensive research on prognostic and predictive markers. A strong correlation of sarcopenia or overall body composition and survival has been described. Here, we explore whether automated assessment of body composition and liver metastases from standard of care CT images can add to clinical parameters in personalized survival risk prognostication. Methods We retrospectively analysed clinical imaging data from 85 patients (50.6% female, mean age 58.9 SD 12.2 years) with colorectal cancer and synchronous liver metastases. Pretrained deep learning models were used to assess body composition and liver metastasis geometry from abdominal CT images before the initiation of systemic treatment. Abdominal muscle-to-bone ratio (MBR) was calculated by dividing abdominal muscle volume by abdominal bone volume. MBR was compared with body mass index (BMI), abdominal muscle volume, and abdominal muscle volume divided by height squared. Differences in overall survival based on body composition and liver metastasis parameters were compared using Kaplan-Meier survival curves. Results were correlated with clinical and biomarker data to develop a machine learning model for survival risk prognostication. ResultsThe MBR, unlike abdominal muscle volume or BMI, was significantly associated with overall survival (HR 0.39, 95% CI: 0.19-0.80, P = 0.009). The MBR (P = 0.022), liver metastasis surface area (P = 0.01) and primary tumour sidedness (P = 0.007) were independently associated with overall survival in multivariate analysis. Body composition parameters did not correlate with KRAS mutational status or primary tumour sidedness. A prediction model based on MBR, liver metastasis surface area and primary tumour sidedness achieved a concordance index of 0.69. Conclusions Automated segmentation enables to extract prognostic parameters from routine imaging data for personalized survival modelling in advanced colorectal cancer patients.
The number of digital medical images is growing constantly over the years. This opens new possibilities of extracting information from them using computer-assisted methods, such as artificial intelligence. 1 In this context, the application of radiomics has received increasing attention since 2012. 2 In radiomics, medical image data is exploited by extracting numerous features from them that are not directly visible to the human eye. These features provide valuable information for diagnosis, prognosis and therapy, especially in cancer research. In this paper, we introduce a web-based radiomics module for end users under StudierFenster (http://www. studierfenster.at), which can extract image features for tumor characterization. StudierFenster is an online, open science medical image processing framework, where multiple clinically relevant modules and applications have been integrated since its initiation in 2018/2019, such as a medical VR viewer and automatic cranial implant design. The newly integrated Radiomics module allows the upload of medical images and segmentations of a region of interest to StudierFenster, where predefined radiomic features are calculated from them using the 'PyRadiomics' Python package. The radiomics module is able to calculate not only the basic first-order statistics of the images, but also more advanced features that capture the 2D/3D shape and gray level characteristics. The design of the radiomics module follows the architecture of StudierFenster, where computation-intensive procedures, such as preprocessing of the data and calculating the features for each image-segmentation pair, are executed on a server. The results are stored in a CSV file, which can afterwards be downloaded in a web-based user interface.
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