Predicting Ki-67 expression level in laryngeal squamous cell carcinoma based on dual energy CT parameters and clinical pathological feature nomogram
ZHENG Pengwei, LIN Guihan, CHEN Weiyue,CHEN Chunmiao, YING Haifeng, JI Jiansong.
Department of Radiology, Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, the Fifth Affiliated Hospital of Wenzhou Medical University,Lishui 323000, China
ZHENG Pengwei,LIN Guihan,CHEN Weiyue, et al. Predicting Ki-67 expression level in laryngeal squamous cell carcinoma based on dual energy CT parameters and clinical pathological feature nomogram[J]. JOURNAL OF WEZHOU MEDICAL UNIVERSITY, 2023, 53(9): 721-728.
Abstract：Objective: To assess the predictive value of a nomogram based on dual-energy CT parameters and clinicopathological features in the preoperative prediction of the Ki-67 expression level in patients with laryngeal squamous-cell carcinoma (LSCC). Methods: A total of 96 LSCC patients who underwent dual-energy CT examination and were pathologically confirmed at the Fifth Affiliated Hospital of Wenzhou Medical University between January 2019 and December 2021 were included. They were randomly divided as training set (67 cases) and validation set (29 cases) at a ratio of 7:3. Patients were classified into Ki-67 high-expression group and Ki-67 low-expression group based on immunohistochemistry results. The clinicopathological features for analysis included age, gender, smoking history, tumor location, clinical T stage, degree of differentiation, and CT-reported lymph node status. Dual-energy CT parameters consisted of standardized iodine concentration (NIC) and energy
spectrum curve slope during arterial and venous phases (λHU) and normalized effective atomic number (nZeff).Logistic regression analysis was performed to identify independent risk factors influencing Ki-67 high expression in LSCC patients. Subsequently, a combined model was developed to integrate clinicopathological features and dual-energy CT parameters, and a nomogram was generated. The performance of the nomogram was evaluated using receiver operating characteristic curve and calibration curve. The clinical utility was assessed using decision curve analysis. Results: In the training set, significant differences were observed in CT-reported lymph node status and differentiation degree between the two groups (all P<0.05). The arterial phase NIC, λHU, nZeff, as well as the venous phase NIC, were significantly higher in the Ki-67 high-expression group than in the Ki-67 lowexpression group (all P<0.05). Multifactorial Logistic regression analysis identified CT-reported positive lymph node (OR=10.219, 95%CI=1.591-65.651), low degree of differentiation (OR=3.555, 95%CI=1.165-10.852), high arterial phase NIC (OR=5.592, 95%CI=1.583-19.751), and high arterial phase nZeff (OR=9.943, 95%CI=1.999-49.450) as independent risk factors for predicting Ki-67 high expression. The nomogram constructed based on the above four indicators exhibited a high predictive performance with area under the curve of being 0.939 and 0.875 in the training set and validation set, respectively. The calibration curve and decision curve analysis demonstrated the robustness and clinical utility of the nomogram. Conclusion: The nomogram based on dualenergy CT parameters and clinicopathological features has significant predictive value in determining Ki-67 expression in patients with LSCC.
