MRI Radiomic Features: Association with Disease-Free Survival in Patients with Triple-Negative Breast Cancer

Radiomic features hold potential to improve prediction of disease-free survival (DFS) in triple-negative breast cancer (TNBC) and may show better performance if developed from TNBC patients. We aimed to develop a radiomics score based on MRI features to estimate DFS in patients with TNBC. A total of 228 TNBC patients who underwent preoperative MRI and surgery between April 2012 and December 2016 were included. Patients were temporally divided into the training (n = 169) and validation (n = 59) set. Radiomic features of the tumor were extracted from T2-weighted and contrast-enhanced T1- weighted MRI. Then a radiomics score was constructed with the least absolute shrinkage and selection operator regression in the training set. Univariate and multivariate Cox proportional hazards models were used to determine what associations the radiomics score and clinicopathologic variables had with DFS. A combined clinicopathologic-radiomic (CCR) model was constructed based on multivariate Cox analysis. The incremental values of the radiomics score were evaluated by using the integrated area under the receiver operating characteristic curve (iAUC) and bootstrapping (n = 1000). The radiomics score, which consisted of 5 selected MRI features, was significantly associated with worse DFS in both the training and validation sets (p = 0.002, p = 0.033, respectively). In both the training and validation set, the radiomics score showed comparable performance with the clinicopathologic model. The CCR model demonstrated better performance than the clinicopathologic model in the training set (iAUC, 0.844; difference in iAUC, p < 0.001) and validation set (iAUC, 0.765, difference in iAUC, p < 0.001). In conclusion, MRI-based radiomic features can improve the prediction of DFS when integrated with clinicopathologic data in patients with TNBC.