Combining the radiomics signature and HPV status for the risk stratification of patients with OPC

Abstract Objective The objective was to perform risk stratification of oropharyngeal cancer (OPC) for treatment de‐escalation based on the radiomics analysis and human papillomavirus (HPV) status. Methods A total of 265 patients with OPC who underwent baseline contrast‐enhanced computed tomography were analyzed, and the patients were grouped into the training ( n = 133) and test ( n = 132) cohorts at a ratio of 1:1. Intratumoral and peritumoral radiomics features were extracted, and the radiomics signature (Rscore) was calculated using least absolute shrinkage and selection operator regression (LASSO) and Cox regression analyses. Results Twelve features were selected to establish the radiomics signature (Rscore) of intratumoral regions +10‐mm peritumoral regions, which yielded maximum AUCs of 0.835, 0.798, and 0.784 in the training, test, and validation cohorts, respectively. Patients with OPC were divided into the high‐risk group, intermediate‐risk group, and low‐risk group based on the Rscore and HPV status and had different prognoses. Patients in the low‐risk group benefit from radiotherapy alone, and patients in the intermediate‐risk group only benefitted from chemoradiotherapy. Conclusion The radiomics signature appears to improve the predictive performance of clinical characteristics for oropharyngeal cancer. The combined stratification of the radiomics signature and HPV status might be preferred to select patients for de‐escalated treatment.