Deep Learning Model of Primary Tumor and Metastatic Cervical Lymph Nodes from CT for Outcome Predictions in Oropharyngeal Cancer

Abstract

Importance: Primary tumor (PT) and metastatic cervical lymph node (LN) characteristics are highly associated with oropharyngeal squamous cell carcinoma (OPSCC) prognosis. Currently, there is a lack of studies to combine imaging characteristics of both regions for predictions of p16+ OPSCC outcomes. Objectives: To develop and validate a computed tomography (CT)-based deep learning classifier that integrates PT and LN features to predict outcomes in p16+ OPSCC and to identify patients with stage I disease who may derive added benefit associated with chemotherapy. Design, Setting, and Participants: In this retrospective prognostic study, radiographic CT scans were analyzed of 811 patients with p16+ OPSCC treated with definitive radiotherapy or chemoradiotherapy from 3 independent cohorts. One cohort from the Cancer Imaging Archive (1998-2013) was used for model development and validation and the 2 remaining cohorts (2002-2015) were used to externally test the model performance. The Swin Transformer architecture was applied to fuse the features from both PT and LN into a multiregion imaging risk score (SwinScore) to predict survival outcomes across and within subpopulations at various stages. Data analysis was performed between February and July 2024. Exposures: Definitive radiotherapy or chemoradiotherapy treatment for patients with p16+ OPSCC. Main Outcomes and Measures: Hazard ratios (HRs), log-rank tests, concordance index (C index), and net benefit were used to evaluate the associations between multiregion imaging risk score and disease-free survival (DFS), overall survival (OS), and locoregional failure (LRF). Interaction tests were conducted to assess whether the association of chemotherapy with outcome significantly differs across dichotomized multiregion imaging risk score subgroups. Results: The total patient cohort comprised 811 patients with p16+ OPSCC (median age, 59.0 years [IQR, 47.4-70.6 years]; 683 men [84.2%]). In the external test set, the multiregion imaging risk score was found to be prognostic of DFS (HR, 3.76 [95% CI, 1.99-7.10]; P