Predicting First-Line VEGFR-TKI Resistance and Survival in Metastatic Clear Cell Renal Cell Carcinoma Using a Clinical-Radiomic Nomogram

Abstract Background：This study aims to construct predicting models using radiomic and clinical features in predicting first-line vascular endothelial growth factor receptor-tyrosine kinase inhibitor (VEGFR-TKI) early resistance in metastatic clear cell renal cell carcinoma (mccRCC) patients. We also aim to explore the correlation of predicting models with short and long-term survival of mccRCC patients. Materials and Methods：In this retrospective study, 110 mccRCC patients from 2009 to 2019 were included and assigned into training and test sets. Radiomic features were extracted from tumor 3D-ROI of baseline enhanced CT images. Radiomic features were selected by Lasso method to construct a radiomic score. A combined nomogram was established using the combination of radiomic score and clinical factors. The discriminative abilities of the radiomic, clinical and combined nomogram were quantified using ROC curve. Cox regression analysis was used to test the correlation of nomogram score with progression-free survival (PFS) and overall survival (OS). PFS and OS were compared between different risk groups by log-rank test. Results：The radiomic, clinical and combined nomogram demonstrated AUCs of 0.81, 0.75, and 0.83 in training set; 0.79, 0.77, and 0.88 in test set. Nomogram score≥1.18 was an independent prognostic factor of PFS (HR 0.22 (0.10, 0.47), p<0.001) and OS (HR 0.38 (0.20, 0.71), p=0.002), in training set. PFS in low-risk group were significantly longer than high-risk group in training (p<0.001) and test (p<0.001) set, respectively. OS in low-risk group were significantly longer than high-risk group in training (p=0.003) and test (p=0.009) set, respectively. Conclusion：A nomogram combining baseline radiomic signature and clinical factors helped detecting first-line VEGFR-TKI early resistance and predicting short and long-term prognosis in mccRCC patients.