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To investigate the prognostic value of peri-tumoral radiomics features of pre-treatment PET/CT images in patients with head and neck cancer. 166 patients from 4 centers (111 for training and 55 for external independent testing) were retrospectively analyzed. 11 regions were used for feature extraction, (1) Intra-tumoral region (Intra) was first dilated radially along the edge by 3, 6, 9, 12 and 15 mm to obtain (2) 5 solid combined regions (noted as Comb&#x005F;3, 6, 9, 12, and 15, respectively), and (3) 5 hollow annular regions with equal ring width of 3 mm were then generated as peri-tumoral regions (noted as Peri&#x005F;3, 6, 9, 12 and 15, respectively). 92 individual/integrated models were constructed by using features from Clinical alone, CT or PET alone, Clinical&#x002B;PET, Clinical&#x002B;CT, PET&#x002B;CT, Clinical&#x002B;PET&#x002B;CT, Intra&#x002B;Peri, Clinical&#x002B;Intra&#x002B;Peri and Clinical&#x002B;PET&#x002B;CT (Intra&#x002B;Peri). In individual models, only 4 models showed p&#x003C;0.05 (PET&#x005F;Peri&#x005F;3 and PET&#x005F;Comb&#x005F;6 for distant metastasis (DM) prediction, Clinical and PET&#x005F;Peri&#x005F;6 for death prediction). In integrated models, Clinical&#x002B;CT (Intra&#x002B;Peri&#x005F;6), PET (Intra&#x002B;Peri&#x005F;3) and Clinical&#x002B;PET&#x005F;Peri&#x005F;6 achieved the best performance for the prediction of local recurrence (LR), DM and death with AUC of 0.75, 0.80 and 0.87, C-index of 0.71, 0.80 and 0.83, p-value of 0.003, 0.008 and 0.001, respectively. Peri-tumoral regions that located closer to the intra-tumoral region (Peri&#x005F;3 and Peri&#x005F;6) showed better performance compared to those located further. The integration of intra-tumoral and peri-tumoral radiomics features achieved better performance than either of them alone, PET and CT radiomics features also provided complementary information to clinical features.

Complementary Value of Intra- and Peri-Tumoral PET/CT Radiomics for Outcome Prediction in Head and Neck Cancer