Value of changes in dual-energy CT iodine concentration parameters before and after neoadjuvant chemo-therapy in predicting two-year post-surgical recurrence of laryngeal squamous cell carcinoma

SHEN Zhuo; LI Qing; JI Xiaodong; YU Zhuo; YANG Xilong; XIA Shuang

doi:10.19300/j.2025.L21843

Abstract：Objective To investigate the predictive value of a model based on iodine concentration parameters derived from dual-energy computed tomography(DECT)for recurrence of laryngeal squamous cell carcinoma(LSCC)within 2 years after surgery in patients who underwent neoadjuvant chemotherapy(NAC).Methods A total of 133 LSCC patients(126 males,7 females;mean age,62±7 years)who underwent NAC and had pathologically confirmed diagnoses after surgery were retrospectively enrolled.Normallized iodine concentration(NIC)values of the tumors were measured in the arterial and venous phases on DECT before and after NAC,and the NIC change rate were calculated.According to the two-year follow-up results,patients were divided into a recurrence group(n=32)and a non-recurrence group(n=101).Differences in clinical and imaging parameters between groups were compared using t-test,Mann-Whitney U test,chi-square test,and Fisher's exact test.Variables with significant differences were entered into binary logistic regression to identify independent predictors of recurrence and to construct a nomogram model.Model performance was assessed using receiver operating characteristic(ROC)curves,area under the curve(AUC),sensitivity,and specificity,while calibration curves were used to evaluate accuracy.Results In the training cohort,significant differences between the recurrence and non-recurrence groups were observed in pre-treatment lymph node status,treatment response based on RECIST criteria,post-treatment NIC in the venous phase,and the NIC venous-phase change rate(all P＜0.05).Logistic regression analysis identified pre-treatment lymph node status,RECIST response,and NIC venous-phase change rate as independent predictors of postoperative recurrence(all P＜0.05).The nomogram constructed from these three factors achieved AUC values＞0.80 in both the training and validation cohorts,with calibration curves demonstrating excellent agreement between predicted and observed outcomes.Conclusion Pre-treatment lymph node status,RECIST treatment response,and NIC venous-phase change rate can effectively predict the risk of two-year recurrence after surgery in LSCC patients receiving NAC.