Prognostic value of MRI radiomics in locally advanced nasopharyngeal carcinoma treated with cisplatin chemoradiotherapy

This study evaluates the efficacy of cisplatin-based concurrent chemoradiotherapy (CCRT) for locally advanced nasopharyngeal carcinoma (LA-NPC) and assesses the prognostic value of MRI texture analysis. In this retrospective cohort study, 100 consecutive LA-NPC patients treated between February 2021 and January 2024 were retrospectively enrolled and allocated based on treatment received: radiotherapy alone (control group, n = 50) or cisplatin CCRT (study group, n = 50). We compared treatment efficacy (objective response rate [ORR] per RECIST 1.1), pain scores (Visual Analogue Scale), anxiety/depression scores (SAS/SDS), survival outcomes (Kaplan-Meier with log-rank tests), and adverse reactions (CTCAE v4.0). Additionally, in a separate radiomics cohort of 60 LA-NPC patients, we performed 3D whole-tumor segmentation on pretreatment MRI images, extracted 396 radiomic features using AI-Kit software, applied LASSO regression for feature selection, and evaluated model performance using 5-fold cross-validation with intra- and inter-observer reproducibility assessment (ICC >0.75). The CCRT group showed significantly higher ORR (82.0% vs. 56.0%; P = 0.006). Patients receiving CCRT experienced lower pain scores at 1-, 2-, and 3-weeks post-treatment, and greater reductions in anxiety and depression (P < 0.001). Survival analysis revealed superior outcomes for the CCRT group: median overall survival (223 vs. 177 days; HR = 0.68, 95% CI: 0.46-0.99, P = 0.048), local recurrence-free survival (68 vs. 47 days; HR = 0.62, 95% CI: 0.40-0.96, P = 0.032), and distant metastasis-free survival (184 vs. 107 days; HR = 0.54, 95% CI: 0.32-0.91, P = 0.018). Adverse reactions were comparable between groups (22.0% vs. 32.0%; P = 0.261). MRI texture analysis identified two predictive features: 135-degree cluster shadow-step 4 (AUC = 0.861, 95% CI: 0.786-0.936) and full-angle correlation variance-step 1 (AUC = 0.758, 95% CI: 0.654-0.862). The combined model achieved an AUC of 0.928 (95% CI: 0.876-0.979; sensitivity: 86.2%; specificity: 83.9%) with good calibration (Hosmer-Lemeshow P = 0.742). Cisplatin-based CCRT significantly improves survival and quality-of-life outcomes in LA-NPC without increasing adverse effects. MRI texture features serve as a promising non-invasive biomarker for predicting treatment response, though prospective validation is required.