A radiomics-boosted deep-learning for risk assessment of synchronous peritoneal metastasis in colorectal cancer

Abstract Objectives Synchronous colorectal cancer peritoneal metastasis (CRPM) has a poor prognosis. This study aimed to create a radiomics-boosted deep learning model by PET/CT image for risk assessment of synchronous CRPM. Methods A total of 220 colorectal cancer (CRC) cases were enrolled in this study. We mapped the feature maps (Radiomic feature maps (RFMs)) of radiomic features across CT and PET image patches by a 2D sliding kernel. Based on ResNet50, a radiomics-boosted deep learning model was trained using PET/CT image patches and RFMs. Besides that, we explored whether the peritumoral region contributes to the assessment of CRPM. In this study, the performance of each model was evaluated by the area under the curves (AUC). Results The AUCs of the radiomics-boosted deep learning model in the training, internal, external, and all validation datasets were 0.926 (95% confidence interval (CI): 0.874–0.978), 0.897 (95% CI: 0.801–0.994), 0.885 (95% CI: 0.795–0.975), and 0.889 (95% CI: 0.823–0.954), respectively. This model exhibited consistency in the calibration curve, the Delong test and IDI identified it as the most predictive model. Conclusions The radiomics-boosted deep learning model showed superior estimated performance in preoperative prediction of synchronous CRPM from pre-treatment PET/CT, offering potential assistance in the development of more personalized treatment methods and follow-up plans. Critical relevance statement The onset of synchronous colorectal CRPM is insidious, and using a radiomics-boosted deep learning model to assess the risk of CRPM before treatment can help make personalized clinical treatment decisions or choose more sensitive follow-up plans. Key Points Prognosis for patients with CRPM is bleak, and early detection poses challenges. The synergy between radiomics and deep learning proves advantageous in evaluating CRPM. The radiomics-boosted deep-learning model proves valuable in tailoring treatment approaches for CRC patients. Graphical Abstract