Selecting Candidates for Organ‐Preserving Strategies After Neoadjuvant Chemoradiotherapy for Rectal Cancer: Development and Validation of a Model Integrating MRI Radiomics and Pathomics

Background Histopathologic evaluation after surgery is the gold standard to evaluate treatment response to neoadjuvant chemoradiotherapy (nCRT) in locally advanced rectal cancer (LARC). However, it cannot be used to guide organ‐preserving strategies due to poor timeliness. Purpose To develop and validate a multiscale model incorporating radiomics and pathomics features for predicting pathological good response (pGR) of down‐staging to stage ypT0‐1N0 after nCRT. Study Type Retrospective. Population A total of 153 patients (median age, 55 years; 109 men; 107 training group; 46 validation group) with clinicopathologically confirmed LARC. Field Strength/Sequence A 3. 0‐T ; fast spin echo T 2 ‐weighted and single‐shot EPI diffusion‐weighted images. Assessment The differences in clinicoradiological variables between pGR and non‐pGR groups were assessed. Pretreatment and posttreatment radiomics signatures, and pathomics signature were constructed. A multiscale pGR prediction model was established. The predictive performance of the model was evaluated and compared to that of the clinicoradiological model. Statistical Tests The χ 2 test, Fisher's exact test, t ‐test, the minimum redundancy maximum relevance algorithm, the least absolute shrinkage and selection operator logistic regression algorithm, regression analysis, receiver operating characteristic curve (ROC) analysis, Delong method. P < 0.05 indicated a significant difference. Results Pretreatment radiomics signature (odds ratio [OR] = 2.53; 95% CI: 1.58–4.66), posttreatment radiomics signature (OR = 9.59; 95% CI: 3.04–41.46), and pathomics signature (OR = 3.14; 95% CI: 1.40–8.31) were independent factors for predicting pGR. The multiscale model presented good predictive performance with areas under the curve (AUC) of 0.93 (95% CI: 0.88–0.98) and 0.90 (95% CI: 0.78–1.00) in the training and validation groups, those were significantly higher than that of the clinicoradiological model with AUCs of 0.69 (95% CI: 0.55–0.82) and 0.68 (95% CI: 0.46–0.91) in both groups. Data Conclusion A model incorporating radiomics and pathomics features effectively predicted pGR after nCRT in patients with LARC. Evidence Level 3 Technical Efficacy Stage 4