Prediction of Local Relapse and Distant Metastasis in Patients with Definitive Chemoradiotherapy-Treated Cervical Cancer by Deep Learning from [18F]-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography

Background: We designed a deep learning model for assessing 18F-FDG PET-CT for early prediction of local and distant failures for patients with locally advanced cervical cancer.   Methods: All 142 patients with cervical cancer underwent 18F-FDG PET-CT for pretreatment staging and received allocated treatment. To augment the amount of image data, each tumor was represented as 11 slice sets each of which contains 3 2D orthogonal slices to acquire a total of 1562 slice sets. In each round of k-fold cross-validation, a well-trained proposed model and a slice-based optimal threshold were derived from training set and used to classify each slice set in the test set into the categories of with or without the local or distant failure. The classification results of each tumor were aggregated to summarize a tumor-based prediction result.   Results: In total, 21 and 26 patients experienced local and distant failures, respectively. Regarding local recurrence, the tumor-based prediction result summarized from all test sets demonstrated that the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 71%, 93%, 63%, 95%, and 89%, respectively. The corresponding values for distant metastasis were 77%, 90%, 63%, 95%, and 87%, respectively.   Conclusion: This is the first study to use deep learning model for assessing 18F-FDG PET-CT images which is capable of predicting treatment outcomes in cervical cancer patients.   Funding Statement: This work was supported by grants from the Ministry of Health and Welfare, Taiwan (MOHW107-TDU-B-212-123004), China Medical University Hospital (DMR-107-192, CRS-106-036, CRS106-039, CRS106-040, CRS106-041); Asia University (DMR-106-150); Academia Sinica Stroke Biosignature Project (BM10701010021); MOST Clinical Trial Consortium for Stroke (MOST 107-2321-B-039 -004-); Tseng-Lien Lin Foundation, Taichung, Taiwan; and Katsuzo and Kiyo Aoshima Memorial Funds, Japan. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. No additional external funding received for this study Declaration of Interests: All authors declare that they have no conflict of interest. Ethics Approval Statement: This study was approved by the local institutional review board (certificate numbers CMUH102-REC2-74 and DMR99-IRB-010-1). Informed consent: This is a retrospective study for images’ analyses. The IRB also specifically waived the consent requirement.