Predictive value of radiomics-based machine learning for the disease-free survival in breast cancer: a systematic review and meta-analysis

PURPOSE: This study summarized the previously-published studies regarding the use of radiomics-based predictive models for the identification of breast cancer-associated prognostic factors, which can help clinical decision-making and follow-up strategy. MATERIALS AND METHODS: This study has been pre-registered on PROSPERO. PubMed, Embase, Cochrane Library, and Web of Science were searched, from inception to April 23, 2022, for studies that used radiomics for prognostic prediction of breast cancer patients. Then the search was updated on July 18, 2023. Quality assessment was conducted using the Radiomics Quality Score, and meta-analysis was performed using R software. RESULTS: A total of 975 articles were retrieved, and 13 studies were included, involving 5014 participants and 35 prognostic models. Among the models, 20 models were radiomics-based and the other 15 were based on clinical or pathological information. The primary outcome was Disease-free Survival (DFS). The retrieved studies were screened using LASSO, and Cox Regression was applied for modeling. The mean RQS was 18. The c-index of radiomics-based models for DFS prediction was 0.763 (95%CI 0.718-0.810) in the training set and 0.702 (95%CI 0.637-0.774) in the validation set. The c-index of combination models was 0.807 (95%CI0.736-0.885) in the training set and 0.840 (95%CI 0.794-0.888) in the validation set. There was no significant change in the c-index of DFS at 1, 2, 3, and over 5 years of follow-up. CONCLUSION: This study has proved that radiomics-based prognostic models are of great predictive performance for the prognosis of breast cancer patients. combination model shows significantly enhanced predictive performance. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42022332392.