Preoperative prediction of regional lymph node metastasis of colorectal cancer based on 18 F-FDG PET/CT and machine learning

Purpose To establish and validate a regional lymph node (LN) metastasis prediction model of colorectal cancer (CRC) based on 18 F-FDG PET/CT and radiomic features using machine-learning methods. Methods A total of 199 colorectal cancer patients underwent pre-therapy diagnostic 18 F-FDG PET/CT scans and CRC radical surgery. The Chang-Gung Image Texture Analysis toolbox (CGITA) was used to extract 70 PET radiomic features reflecting 18 F-FDG uptake heterogeneity of tumors. The least absolute shrinkage and selection operator (LASSO) algorithm was used to select radiomic features and develop a radiomic signature score (Rad-score). The training set was used to establish five machine-learning prediction models and the test set was used to test the efficacy of the models. The effectiveness of the models was compared by ROC analysis. Results The CRC patients were divided into a training set ( n = 144) and a test set ( n = 55). Two radiomic features were selected to build the Rad-score. Five machine-learning algorithms including logistic regression, support vector machine (SVM), random forest, neural network and eXtreme gradient boosting (XGBoost) were used to established models. Among the five machine-learning models, logistic regression (AUC 0.866, 95% CI 0.808–0.925) and XGBoost (AUC 0.903, 95% CI 0.855–0.951) models performed the best. In the training set, the AUC of these two models were significantly higher than that of the LN metastasis status reported by 18 F-FDG PET/CT for differentiating positive and negative regional LN metastases in CRC (all p < 0.05). Good efficacy of the above two models was also achieved in the test set. We created a nomogram based on the logistic regression model that visualized the results and provided an easy-to-use method for predicting regional LN metastasis in patients with CRC. Conclusion In this study, five machine-learning models for preoperative prediction of regional LN metastasis of CRC based on 18 F-FDG PET/CT and PET-based radiomic features were successfully developed and validated. Among them, the logistic regression and XGBoost models performed the best, with higher efficacy than 18 F-FDG PET/CT in both the training and test sets.