机器学习模型对食管癌浸润深度的诊断价值:基于影像组学特征和深度学习特征的比较

Diagnostic value of machine learning models for depth of invasion in esophageal cancer: A comparison based on radiomic features and deep learning features

  • 摘要: 背景 食管癌是全球癌症相关死亡的主要病因之一,其治疗方案的选择高度依赖于术前精准的浸润深度分期。准确区分肿瘤是否局限于黏膜层(Tis-T1a 期)或侵犯至黏膜下层以深(T1b-T3 期),是决定内镜下微创治疗或外科手术的关键。目的 构建一个基于CT影像组学的机器学习模型用于术前无创区分食管癌Tis-T1a 期与T1b-T3 期病变,评价模型的性能。方法 数据来源于解放军总医院第一医学中心2018 年1 月到2025 年6 月收治的经病理证实的食管癌患者的临床及影像学资料。采用Python 3.9 软件,从每例患者的术前CT图像中提取相关影像组学特征形成影像组学特征集合,基于CT影像采用3D-ResNet 提取深度学习(deep learning-based model,DL)特征建立深度学习特征集合,采用LASSO回归方法对2 个特征集合进行筛选。以2 个集合筛选后的特征为分析指标,以全部病例为训练集,采用支持向量机(Support Vector Machine,SVM)、随机森林(Random Forest,RF)、随机梯度下降(Stochastic Gradient Descent,SGD)、k 近邻(k-Nearest Neighbors,KNN)、极端梯度增强(eXtreme Gradient Boosting, XGBoost) 和轻量级梯度提升机(Light Gradient Boosting Machine,LightGBM)6 个机器学习模型,建立影像组学模型(radiomics model,Rad)、深度学习模型(deep learning,DL)以及二者组合的复合模型(Rad+DL)诊断Tis-T1a 期与T1b-T3 期病变,并采用Bootstrap 法(1 000 次重复抽样)形成验证集进行内部验证,使用受试者工作特征(receiver operating characteristic,ROC)曲线分析评估所构建模型的诊断性能,校准度通过校准曲线评估,临床实用性通过决策曲线分析量化其在不同阈值概率下的净获益。结果 数据集共包含340 例食管癌患者,其中男性292例,女性48 例,平均年龄(61.97±7.58)岁;Tis-T1a 期68 例,T1b-T3 期272 例。在1 130 个影像组学特征和512 个深度学习特征中,经LASSO回归筛选后分别保留9 个影像组学特征和11 个深度学习特征用于模型构建。6 种机器学习算法中RF综合表现最优。采用RF的3 个模型中Rad+DL比Rad和DL模型诊断性能更优。ROC曲线下面积(area under the curve,AUC)在训练集中分别为0.877、0.816 和0.799;在验证集中,其AUC分别为0.794、0.785 和0.678。决策曲线分析进一步证实,Rad+DL在广泛的阈值概率范围内均有重要的临床应用价值,且显著优于Rad 和DL。校准曲线分析显示Rad+DL模型的诊断与实际结果具有良好的一致性。结论 本研究成功构建的复合模型能够有效利用CT影像数据,术前无创鉴别食管癌的肿瘤浸润深度(Tis-T1a 期 vs T1b-T3 期),具有较高的准确性。该模型可为临床制定个体化治疗方案(尤其是选择内镜或手术治疗)提供有价值的影像学参考依据。

     

    Abstract: Background Esophageal cancer is one of the leading causes of cancer-related deaths worldwide, and the choice of treatment strategy heavily depends on accurate preoperative staging of the depth of tumor invasion. Precisely distinguishing whether the tumor is confined to the mucosa (stages Tis-T1a) or has invaded beyond the submucosa (stages T1b-T3) is crucial for deciding between endoscopic minimally invasive treatment and surgical resection. Objective To develop and validate an integrated model based on CT radiomics and machine learning for the preoperative non-invasive discrimination between stage Tis-T1a and stage T1b- T3 lesions in esophageal cancer. Methods Clinical and imaging data were collected from patients with pathologically confirmed esophageal cancer treated at the First Medical Center of PLA General Hospital from January 2018 to June 2025. Using Python 3.9, radiomic features were extracted from the preoperative CT images of each patient to form a radiomic feature set. Concurrently, deep learning features were extracted from the CT images using a 3D-ResNet architecture to establish a deep learning feature set. Least Absolute Shrinkage and Selection Operator (LASSO) regression was applied to select features from both sets. Using the selected features from the two sets as analytical variables and the entire cohort as the training set, six machine learning algorithms—Support Vector Machine (SVM), Random Forest (RF), Stochastic Gradient Descent (SGD), k-Nearest Neighbors (KNN), eXtreme Gradient Boosting (XGBoost), and Light Gradient Boosting Machine (LightGBM) —were employed to develop three types of models: a radiomics model (Rad), a deep learning-based model (DL), and a combined model (Rad+DL) for diagnosing Tis-T1a versus T1b-T3 lesions. Internal validation was performed using the Bootstrap method with 1 000 resampling iterations. The diagnostic performance of the constructed models was evaluated using receiver operating characteristic (ROC) curve analysis. Calibration was assessed via calibration curves, and clinical utility was quantified by net benefit across different threshold probabilities using decision curve analysis (DCA). Results A total of 340 patients with esophageal cancer were included in the dataset, comprising 292 males and 48 females, with a mean age of 61.97 ± 7.58 years. Among them, 68 patients were staged as Tis-T1a and 272 as T1b-T3. From an initial pool of 1 130 radiomic features and 512 deep learning features, LASSO regression selected 9 radiomic features and 11 deep learning features, respectively, for model construction. Among the 6 machine learning algorithms, RF demonstrated the best overall performance. Among the three models constructed using RF, the Rad+DL model exhibited superior diagnostic performance compared to the Rad and DL models alone. The areas under the ROC curve (AUC) for the three models in the training set were 0.877, 0.816, and 0.799, respectively; in the validation set, the corresponding AUC values were 0.794, 0.785, and 0.678. Decision curve analysis further confirmed that the Rad+DL model provided significant clinical net benefit across a wide range of threshold probabilities, substantially outperforming both the Rad and DL models. Calibration curve analysis demonstrated good agreement between the diagnostic accuracy of the Rad+DL model and the actual observed outcomes. Conclusion The combined model successfully developed in this study can effectively utilize CT imaging data for the preoperative non-invasive discrimination of the depth of tumor invasion in esophageal cancer (Tis-T1a vs T1b-T3), demonstrating high accuracy. The model provides valuable imaging-based reference for clinicians to formulate individualized treatment plans, especially when choosing between endoscopic or surgical approaches.

     

/

返回文章
返回