Research Paper Volume 12, Issue 14 pp 14593—14619

Radiomics-based prediction of survival in patients with head and neck squamous cell carcinoma based on pre- and post-treatment 18F-PET/CT

Zheran Liu1, *, , Yuan Cao2, *, , Wei Diao2, , Yue Cheng3, , Zhiyun Jia2, , Xingchen Peng1, ,

  • 1 Department of Biotherapy, Cancer Center, West China Hospital of Sichuan University, Chengdu 610041, China
  • 2 Department of Nuclear Medicine, West China Hospital of Sichuan University, Chengdu 610041, China
  • 3 Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, China
* Equal contribution

Received: March 11, 2020       Accepted: June 4, 2020       Published: July 16, 2020
How to Cite

Copyright © 2020 Liu et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY 3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


Background: 18-fluorodeoxyglucose positron emission tomography/computed tomography (18F-PET/CT) has been widely applied for the imaging of head and neck squamous cell carcinoma (HNSCC). This study examined whether pre- and post-treatment 18F-PET/CT features can help predict the survival of HNSCC patients.

Results: Three radiomics features were identified as prognostic factors. Radiomics score calculated from these features significantly predicted overall survival (OS) and disease-free disease (DFS). The clinicopathological characteristics combined with pre- or post-treatment nomograms showed better ROC curves and decision curves than the nomogram based only on clinicopathological characteristics.

Conclusions: Combining clinicopathological characteristics with radiomics features of pre-treatment PET/CT or post-treatment PET/CT assessment of primary tumor sites as positive or negative may substantially improve prediction of OS and DFS of HNSCC patients.

Methods: 171 patients who received pre-treatment 18F-PET/CT scans and 154 patients who received post-treatment 18F-PET/CT scans with HNSCC in the Cancer Imaging Achieve (TCIA) were included. Nomograms that combined clinicopathological features with either pre-treatment PET/CT radiomics features or post-treatment assessment of primary tumor sites were constructed using data from 154 HNSCC patients. Receiver operating characteristic (ROC) curves and decision curves were used to compare the predictions of these models with those of a model incorporating only clinicopathological features.


AJCC: American Joint Committee on Cancer; BMI: body mass index; CT: computed tomography; C-index: the concordance index; DCA: Decision Curve Analysis; DFS: disease-free survival; 18F-FDG PET/CT: fluorine-18-fluorodeoxyglucose tomography/computed tomography; HNSCC: head and neck squamous cell carcinoma; HR: Hazard ratio; LASSO: The least absolute shrinkage and selection operator; MTV: metabolic tumor value; MRI: magnetic resonance imaging; OS: overall survival; ROC: receiver operating characteristic; SUV: standardized uptake values; TLG: total lesion glycolysis.