Sub-regional radiomics combining multichannel 2-dimensional or 3-dimensional deep learning for predicting neoadjuvant chemo-immunotherapy response in esophageal squamous cell carcinoma: a multicenter study
Jiahao Zhu, Benjie Xu, Tiantian Fan, Shengjun Ji, Ke Gu, Jiaxuan Ding, Haiquan Lu, Jianqun Ma, Yang Zhou
Abstract
This study aimed to develop and compare fusion models combining sub-regional radiomics with multichannel 2D and 3D DL to predict pCR in patients with LA-ESCC undergoing NACI. A total of 271 patients from three hospitals were divided into training, internal validation, and external validation cohorts. Tumor sub-regions were identified using K-means clustering based on radiomic features, and predictive features were extracted using PyRadiomics. Among all models, the DLRad1 model (radiomics + 2D DL) demonstrated the highest performance, with an AUC ranging from 0.793 to 0.910 across cohorts. Sub-region 1 features alone achieved an AUC of 0.823, while DLRad2 (radiomics + 3D DL) and other single-modality models showed lower AUCs (0.701-0.906). Spearman correlation analysis confirmed low redundancy among selected features. These findings support DLRad1 as a promising non-invasive tool to identify LA-ESCC patients most likely to benefit from NACI, potentially aiding personalized treatment decisions.