An Automatic Deep Learning–Based Workflow for Glioblastoma Survival Prediction Using Preoperative Multimodal MR Images: A Feasibility Study

We proposed a fully automatic workflow for glioblastoma (GBM) survival prediction using deep learning (DL) methods. 285 glioma (210 GBM, 75 low-grade glioma) patients were included. 163 of the GBM patients had overall survival (OS) data. Every patient had four pre-operative MR scans and manually drawn tumor contours. For automatic tumor segmentation, a 3D convolutional neural network (CNN) was trained and validated using 122 glioma patients. The trained model was applied to the remaining 163 GBM patients to generate tumor contours. The handcrafted and DL-based radiomic features were extracted from auto-contours using explicitly designed algorithms and a pre-trained CNN respectively. 163 GBM patients were randomly split into training (n=122) and testing (n=41) sets for survival analysis. Cox regression models with regularization techniques were trained to construct the handcrafted and DL-based signatures. The prognostic power of the two signatures was evaluated and compared. The 3D CNN achieved an average Dice coefficient of 0.85 across 163 GBM patients for tumor segmentation. The handcrafted signature achieved a C-index of 0.64 (95% CI: 0.55-0.73), while the DL-based signature achieved a C-index of 0.67 (95% CI: 0.57-0.77). Unlike the handcrafted signature, the DL-based signature successfully stratified testing patients into two prognostically distinct groups (p-value<0.01, HR=2.80, 95% CI: 1.26-6.24). The proposed 3D CNN generated accurate GBM tumor contours from four MR images. The DL-based signature resulted in better GBM survival prediction, in terms of higher C-index and significant patient stratification, than the handcrafted signature. The proposed automatic radiomic workflow demonstrated the potential of improving patient stratification and survival prediction in GBM patients.