External validation of a prognostic model incorporating quantitative PET image features in oesophageal cancer

Kieran G. Foley*, Zhenwei Shi, Philip Whybra, Petros Kalendralis, Ruben Larue, Maaike Berbee, Meindert N. Sosef, Craig Parkinson, John Staffurth, Tom D. L. Crosby, Stuart Ashley Roberts, Andre Dekker, Leonard Wee, Emiliano Spezi

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Aim: Enhanced prognostic models are required to improve risk stratification of patients with oesophageal cancer so treatment decisions can be optimised. The primary aim was to externally validate a published prognostic model incorporating PET image features. Transferability of the model was compared using only clinical variables.

Methods: This was a Transparent Reporting of amultivariate prediction model for Individual Prognosis Or Diagnosis (TRIPOD) type 3 study. The model was validated against patients treated with neoadjuvant chemoradiotherapy according to the Neoadjuvant chemoradiotherapy plus surgery versus surgery alone for oesophageal or junctional cancer (CROSS) trial regimen using pre-and post-harmonised image features. The Kaplan-Meier method with log-rank significance tests assessed risk strata discrimination. A Cox proportional hazards model assessed model calibration. Primary outcome was overall survival (OS).

Results: Between 2010 and 2015, 449 patients were included in the development (n = 302), internal validation (n = 101) and external validation (n = 46) cohorts. No statistically significant difference in OS between patient quartiles was demonstrated in prognostic models incorporating PET image features (X-2 = 1.42, df = 3, p = 0.70) or exclusively clinical variables (age, disease stage and treatment; X-2 = 1.19, df = 3, p = 0.75). The calibration slope b of both models was not significantly different from unity (p = 0.29 and 0.29, respectively). Risk groups defined using only clinical variables suggested differences in OS, although these were not statistically significant (X-2 = 0.71, df = 2, p = 0.70).

Conclusion: The prognostic model did not enable significant discrimination between the validation risk groups, but a second model with exclusively clinical variables suggested some transferable prognostic ability. PET harmonisation did not significantly change the results of model validation. Crown Copyright (C) 2018 Published by Elsevier B.V. All rights reserved.

Original languageEnglish
Pages (from-to)205-212
Number of pages8
JournalRadiotherapy and Oncology
Publication statusPublished - Apr 2019


  • Oesophageal cancer
  • Positron-emission tomography
  • Radiomics
  • Survival
  • Prognosis


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