Prognostic value of pretreatment MRI texture features in breast cancer brain metastasis treated with Gamma Knife radiosurgery

Abstract

Background Gamma Knife radiosurgery (GKS) was recommended for treating patients with breast cancer brain metastasis (BCBM), but predictions of the existing prognostic models for therapeutic responsiveness vary substantially. Purpose To investigate the prognostic value of pretreatment clinical, MRI radiologic, and texture features in patients with BCBM undergoing GKS. Material and Methods The data of 81 BCBMs in 44 patients were retrospectively reviewed. Progressive disease was defined as an increase of at least 20% in the longest diameter of the target lesion or the presence of new intracranial lesions on contrast-enhanced T1-weighted (CE-T1W) imaging. Radiomic features were extracted from pretreatment CE-T1W images, T2-weighted (T2W) images, and ADC maps. Cox proportional hazard analyses were performed to identify independent predictors associated with BCBM-specific progression-free survival (PFS). A nomogram was constructed and its calibration ability was assessed. Results The cumulative BCBM-specific PFS was 52.27% at six months and 11.36% at one year, respectively. Age (hazard ratio [HR] 1.04; 95% confidence interval [CI] 1.01–1.06; P = 0.004) and CE-T1W-based kurtosis (HR 0.72; 95% CI 0.57–0.92; P = 0.008) were the independent predictors. The combination of CE-T1W-based kurtosis and age displayed a higher C-index (C-index 0.70; 95% CI 0.63–0.77) than did CE-T1W-based kurtosis (C-index 0.65; 95% CI 0.57–0.73) or age (C-index 0.63; 95% CI 0.56–0.70) alone. The nomogram based on the combinative model provided a better performance over age ( P < 0.05). The calibration curves elucidated good agreement between prediction and observation for the probability of 7- and 12-month BCBM-specific PFS. Conclusion Pretreatment CE-T1W-based kurtosis combined with age could improve prognostic ability in patients with BCBM undergoing GKS.