Radiomics Profiling Identifies the Incremental Value of MRI Features beyond Key Molecular Biomarkers for the Risk Stratification of High-Grade Gliomas

Objective. To identify the incremental value of magnetic resonance imaging (MRI) features beyond key molecular biomarkers for the risk stratification of high-grade gliomas (HGGs). Methods. A total of 241 patients with preoperative magnetic resonance (MR) images and clinical and genetic data were retrospectively collected from our institution and The Cancer Genome Atlas/The Cancer Imaging Archive (TCGA/TCIA) dataset. Radiomic features (n = 1702) were extracted from both postcontrast T1-weighted (CE-T1) and T2-weighted fluid attenuation inversion recovery (T2FLAIR) MR images. The least absolute shrinkage and selection operator (LASSO) method was used to select effective features. A multivariate Cox proportional risk regression model was established to explore the prognostic value of clinical features, molecular biomarkers, and radiomic features. Kaplan-Meier survival analysis and the log-rank test were used to evaluate the prognostic model, and a stratified analysis was conducted to demonstrate the incremental value of the radiomics signature. A nomogram was developed to predict the 1-year, 2-year, and 3-year overall survival (OS) probabilities of the patients with HGGs. Results. The radiomics signature provided significant prognostic value for the risk stratification of patients with HGGs. The combined model integrating the radiomics signature with clinical data (age) and O-6-methylguanine-DNA methyltransferase (MGMT) promoter methylation status had the best prognostic value, with C-index values of 0.752 and 0.792 in the training set and external validation set, respectively. Stratified Kaplan-Meier survival analysis showed that the radiomics signature could identify the risk subgroups in different clinical and molecular subgroups. Conclusion. This radiomics signature can be used for the risk stratification of patients with HGGs and has incremental value beyond key molecular biomarkers, providing a preoperative basis for individualized diagnosis and treatment decision-making.