Deep learning-based radiomics predicts response to chemotherapy in colorectal liver metastases

Purpose: The purpose of this study was to develop and validate a deep learning (DL)-based radiomics model to predict the response to chemotherapy in colorectal liver metastases (CRLM). Methods: In this retrospective study, we enrolled 192 patients diagnosed with CRLM who received first-line chemotherapy and were followed by response assessment. Tumor response was identified according to the Response Evaluation Criteria in Solid Tumors (RECIST). Contrast-enhanced multidetector computed tomography (MDCT) images were fed as inputs of the ResNet10-based DL radiomics model, and the possibility of response was predicted as the output. The final combined DL radiomics model was constructed by integrating the response-related clinical factors and the developed DL radiomics signature. A time-independent validation cohort (n = 48) was extracted from the 192 patients to evaluate the DL model with area under the receiver operating characteristic curve (AUC), specificity, and sensitivity. Meanwhile, a traditional radiomics model was constructed using least absolute shrinkage and selection operator (lasso) as comparisons with the DL-based model. Results: According to RECIST criteria, 131 patients were identified as responders with complete response, partial response, and stable disease, while 61 patients were nonresponders with progression disease. The selected predictive clinical factor turned out to be the carcinoembryonic antigen (CEA) level with AUC of 0.489 (95% confidence interval [CI], 0.380–0.599) and 0.558 (95% CI, 0.374–0.741) in the training and validation cohorts, respectively. The DL-based model provided better performance than the traditional classifier-based radiomics model with significantly higher AUC (training: 0.903 [95% CI, 0.851–0.955] vs 0.745 [95% CI, 0.659–0.831]; validation: 0.820 [95% CI, 0.681–0.959] vs 0.598 [95% CI, 0.422–0.774]). The combination of DL-based model with the CEA level provided slightly increased performance with AUC of 0.935 [95% CI, 0.897–0.973] in the training cohort and 0.830 [95% CI, 0.688-0.973] in the validation cohort. Conclusions: The developed DL-based radiomics model could improve the efficiency to predict the response to chemotherapy in CRLM, which may assist in subsequent personalized treatment decision-making in CRLM management.