title: MR Imaging Radiomics Signatures for Predicting the Risk of Breast Cancer Recurrence as Given by Research Versions of MammaPrint, Oncotype DX, and PAM50 Gene Assays.
abstract: Purpose To investigate relationships between computer-extracted breast magnetic resonance (MR) imaging phenotypes with multigene assays of MammaPrint, Oncotype DX, and PAM50 to assess the role of radiomics in evaluating the risk of breast cancer recurrence. Materials and Methods Analysis was conducted on an institutional review board-approved retrospective data set of 84 deidentified, multi-institutional breast MR examinations from the National Cancer Institute Cancer Imaging Archive, along with clinical, histopathologic, and genomic data from The Cancer Genome Atlas. The data set of biopsy-proven invasive breast cancers included 74 (88%) ductal, eight (10%) lobular, and two (2%) mixed cancers. Of these, 73 (87%) were estrogen receptor positive, 67 (80%) were progesterone receptor positive, and 19 (23%) were human epidermal growth factor receptor 2 positive. For each case, computerized radiomics of the MR images yielded computer-extracted tumor phenotypes of size, shape, margin morphology, enhancement texture, and kinetic assessment. Regression and receiver operating characteristic analysis were conducted to assess the predictive ability of the MR radiomics features relative to the multigene assay classifications. Results Multiple linear regression analyses demonstrated significant associations (R2= 0.25-0.32, r = 0.5-0.56, P < .0001) between radiomics signatures and multigene assay recurrence scores. Important radiomics features included tumor size and enhancement texture, which indicated tumor heterogeneity. Use of radiomics in the task of distinguishing between good and poor prognosis yielded area under the receiver operating characteristic curve values of 0.88 (standard error, 0.05), 0.76 (standard error, 0.06), 0.68 (standard error, 0.08), and 0.55 (standard error, 0.09) for MammaPrint, Oncotype DX, PAM50 risk of relapse based on subtype, and PAM50 risk of relapse based on subtype and proliferation, respectively, with all but the latter showing statistical difference from chance. Conclusion Quantitative breast MR imaging radiomics shows promise for image-based phenotyping in assessing the risk of breast cancer recurrence.©RSNA, 2016 Online supplemental material is available for this article.
authors.affiliation: From the Depts of Radiology (H.L., K.D., M.L.G.) and Public Health Sciences (Y.J.), The Univ of Chicago, 5841 S Maryland Ave, MC 2026, Chicago, IL 60637; Program of Computational Genomics & Medicine, NorthShore Univ HealthSystem, Evanston, Ill (Y.Z., Y.J.); Dept of Radiology, Univ of Wisconsin-Madison, Madison, Wis (E.S.B.); Lineberger Comprehensive Cancer Ctr, Univ of North Carolina, Chapel Hill, NC (K.A.H., C.F., C.M.P.); Dept of Medicine, Section of Hematology & Oncology, The Univ of Chicago, Chicago, Ill (S.D.C.); Dept of Diagnostic Radiology, The Univ of Texas MD Anderson Cancer Ctr, Houston, Tex (G.J.W.); Dept of Radiology, Memorial Sloan-Kettering Cancer Ctr, New York, NY (E.J.S., E.A.M.); Dept of Radiology, Univ of Miami Sylvester Comprehensive Cancer Ctr, Miami, Fla (J.M.N.); Dept of Radiology, Univ of Pittsburgh Medical Ctr, Pittsburgh, Pa (M.G.); and Div of Cancer Treatment and Diagnosis, National Cancer Inst, Biometric Research Branch, Bethesda, Md (E.H.).
authors.forename: Hui
authors.initials: H
authors.lastname: Li
authors.affiliation: From the Depts of Radiology (H.L., K.D., M.L.G.) and Public Health Sciences (Y.J.), The Univ of Chicago, 5841 S Maryland Ave, MC 2026, Chicago, IL 60637; Program of Computational Genomics & Medicine, NorthShore Univ HealthSystem, Evanston, Ill (Y.Z., Y.J.); Dept of Radiology, Univ of Wisconsin-Madison, Madison, Wis (E.S.B.); Lineberger Comprehensive Cancer Ctr, Univ of North Carolina, Chapel Hill, NC (K.A.H., C.F., C.M.P.); Dept of Medicine, Section of Hematology & Oncology, The Univ of Chicago, Chicago, Ill (S.D.C.); Dept of Diagnostic Radiology, The Univ of Texas MD Anderson Cancer Ctr, Houston, Tex (G.J.W.); Dept of Radiology, Memorial Sloan-Kettering Cancer Ctr, New York, NY (E.J.S., E.A.M.); Dept of Radiology, Univ of Miami Sylvester Comprehensive Cancer Ctr, Miami, Fla (J.M.N.); Dept of Radiology, Univ of Pittsburgh Medical Ctr, Pittsburgh, Pa (M.G.); and Div of Cancer Treatment and Diagnosis, National Cancer Inst, Biometric Research Branch, Bethesda, Md (E.H.).
authors.forename: Yitan
authors.initials: Y
authors.lastname: Zhu
authors.affiliation: From the Depts of Radiology (H.L., K.D., M.L.G.) and Public Health Sciences (Y.J.), The Univ of Chicago, 5841 S Maryland Ave, MC 2026, Chicago, IL 60637; Program of Computational Genomics & Medicine, NorthShore Univ HealthSystem, Evanston, Ill (Y.Z., Y.J.); Dept of Radiology, Univ of Wisconsin-Madison, Madison, Wis (E.S.B.); Lineberger Comprehensive Cancer Ctr, Univ of North Carolina, Chapel Hill, NC (K.A.H., C.F., C.M.P.); Dept of Medicine, Section of Hematology & Oncology, The Univ of Chicago, Chicago, Ill (S.D.C.); Dept of Diagnostic Radiology, The Univ of Texas MD Anderson Cancer Ctr, Houston, Tex (G.J.W.); Dept of Radiology, Memorial Sloan-Kettering Cancer Ctr, New York, NY (E.J.S., E.A.M.); Dept of Radiology, Univ of Miami Sylvester Comprehensive Cancer Ctr, Miami, Fla (J.M.N.); Dept of Radiology, Univ of Pittsburgh Medical Ctr, Pittsburgh, Pa (M.G.); and Div of Cancer Treatment and Diagnosis, National Cancer Inst, Biometric Research Branch, Bethesda, Md (E.H.).
authors.forename: Elizabeth S
authors.initials: ES
authors.lastname: Burnside
authors.affiliation: From the Depts of Radiology (H.L., K.D., M.L.G.) and Public Health Sciences (Y.J.), The Univ of Chicago, 5841 S Maryland Ave, MC 2026, Chicago, IL 60637; Program of Computational Genomics & Medicine, NorthShore Univ HealthSystem, Evanston, Ill (Y.Z., Y.J.); Dept of Radiology, Univ of Wisconsin-Madison, Madison, Wis (E.S.B.); Lineberger Comprehensive Cancer Ctr, Univ of North Carolina, Chapel Hill, NC (K.A.H., C.F., C.M.P.); Dept of Medicine, Section of Hematology & Oncology, The Univ of Chicago, Chicago, Ill (S.D.C.); Dept of Diagnostic Radiology, The Univ of Texas MD Anderson Cancer Ctr, Houston, Tex (G.J.W.); Dept of Radiology, Memorial Sloan-Kettering Cancer Ctr, New York, NY (E.J.S., E.A.M.); Dept of Radiology, Univ of Miami Sylvester Comprehensive Cancer Ctr, Miami, Fla (J.M.N.); Dept of Radiology, Univ of Pittsburgh Medical Ctr, Pittsburgh, Pa (M.G.); and Div of Cancer Treatment and Diagnosis, National Cancer Inst, Biometric Research Branch, Bethesda, Md (E.H.).
authors.forename: Karen
authors.initials: K
authors.lastname: Drukker
authors.affiliation: From the Depts of Radiology (H.L., K.D., M.L.G.) and Public Health Sciences (Y.J.), The Univ of Chicago, 5841 S Maryland Ave, MC 2026, Chicago, IL 60637; Program of Computational Genomics & Medicine, NorthShore Univ HealthSystem, Evanston, Ill (Y.Z., Y.J.); Dept of Radiology, Univ of Wisconsin-Madison, Madison, Wis (E.S.B.); Lineberger Comprehensive Cancer Ctr, Univ of North Carolina, Chapel Hill, NC (K.A.H., C.F., C.M.P.); Dept of Medicine, Section of Hematology & Oncology, The Univ of Chicago, Chicago, Ill (S.D.C.); Dept of Diagnostic Radiology, The Univ of Texas MD Anderson Cancer Ctr, Houston, Tex (G.J.W.); Dept of Radiology, Memorial Sloan-Kettering Cancer Ctr, New York, NY (E.J.S., E.A.M.); Dept of Radiology, Univ of Miami Sylvester Comprehensive Cancer Ctr, Miami, Fla (J.M.N.); Dept of Radiology, Univ of Pittsburgh Medical Ctr, Pittsburgh, Pa (M.G.); and Div of Cancer Treatment and Diagnosis, National Cancer Inst, Biometric Research Branch, Bethesda, Md (E.H.).
authors.forename: Katherine A
authors.initials: KA
authors.lastname: Hoadley
authors.affiliation: From the Depts of Radiology (H.L., K.D., M.L.G.) and Public Health Sciences (Y.J.), The Univ of Chicago, 5841 S Maryland Ave, MC 2026, Chicago, IL 60637; Program of Computational Genomics & Medicine, NorthShore Univ HealthSystem, Evanston, Ill (Y.Z., Y.J.); Dept of Radiology, Univ of Wisconsin-Madison, Madison, Wis (E.S.B.); Lineberger Comprehensive Cancer Ctr, Univ of North Carolina, Chapel Hill, NC (K.A.H., C.F., C.M.P.); Dept of Medicine, Section of Hematology & Oncology, The Univ of Chicago, Chicago, Ill (S.D.C.); Dept of Diagnostic Radiology, The Univ of Texas MD Anderson Cancer Ctr, Houston, Tex (G.J.W.); Dept of Radiology, Memorial Sloan-Kettering Cancer Ctr, New York, NY (E.J.S., E.A.M.); Dept of Radiology, Univ of Miami Sylvester Comprehensive Cancer Ctr, Miami, Fla (J.M.N.); Dept of Radiology, Univ of Pittsburgh Medical Ctr, Pittsburgh, Pa (M.G.); and Div of Cancer Treatment and Diagnosis, National Cancer Inst, Biometric Research Branch, Bethesda, Md (E.H.).
authors.forename: Cheng
authors.initials: C
authors.lastname: Fan
authors.affiliation: From the Depts of Radiology (H.L., K.D., M.L.G.) and Public Health Sciences (Y.J.), The Univ of Chicago, 5841 S Maryland Ave, MC 2026, Chicago, IL 60637; Program of Computational Genomics & Medicine, NorthShore Univ HealthSystem, Evanston, Ill (Y.Z., Y.J.); Dept of Radiology, Univ of Wisconsin-Madison, Madison, Wis (E.S.B.); Lineberger Comprehensive Cancer Ctr, Univ of North Carolina, Chapel Hill, NC (K.A.H., C.F., C.M.P.); Dept of Medicine, Section of Hematology & Oncology, The Univ of Chicago, Chicago, Ill (S.D.C.); Dept of Diagnostic Radiology, The Univ of Texas MD Anderson Cancer Ctr, Houston, Tex (G.J.W.); Dept of Radiology, Memorial Sloan-Kettering Cancer Ctr, New York, NY (E.J.S., E.A.M.); Dept of Radiology, Univ of Miami Sylvester Comprehensive Cancer Ctr, Miami, Fla (J.M.N.); Dept of Radiology, Univ of Pittsburgh Medical Ctr, Pittsburgh, Pa (M.G.); and Div of Cancer Treatment and Diagnosis, National Cancer Inst, Biometric Research Branch, Bethesda, Md (E.H.).
authors.forename: Suzanne D
authors.initials: SD
authors.lastname: Conzen
authors.affiliation: From the Depts of Radiology (H.L., K.D., M.L.G.) and Public Health Sciences (Y.J.), The Univ of Chicago, 5841 S Maryland Ave, MC 2026, Chicago, IL 60637; Program of Computational Genomics & Medicine, NorthShore Univ HealthSystem, Evanston, Ill (Y.Z., Y.J.); Dept of Radiology, Univ of Wisconsin-Madison, Madison, Wis (E.S.B.); Lineberger Comprehensive Cancer Ctr, Univ of North Carolina, Chapel Hill, NC (K.A.H., C.F., C.M.P.); Dept of Medicine, Section of Hematology & Oncology, The Univ of Chicago, Chicago, Ill (S.D.C.); Dept of Diagnostic Radiology, The Univ of Texas MD Anderson Cancer Ctr, Houston, Tex (G.J.W.); Dept of Radiology, Memorial Sloan-Kettering Cancer Ctr, New York, NY (E.J.S., E.A.M.); Dept of Radiology, Univ of Miami Sylvester Comprehensive Cancer Ctr, Miami, Fla (J.M.N.); Dept of Radiology, Univ of Pittsburgh Medical Ctr, Pittsburgh, Pa (M.G.); and Div of Cancer Treatment and Diagnosis, National Cancer Inst, Biometric Research Branch, Bethesda, Md (E.H.).
authors.forename: Gary J
authors.initials: GJ
authors.lastname: Whitman
authors.affiliation: From the Depts of Radiology (H.L., K.D., M.L.G.) and Public Health Sciences (Y.J.), The Univ of Chicago, 5841 S Maryland Ave, MC 2026, Chicago, IL 60637; Program of Computational Genomics & Medicine, NorthShore Univ HealthSystem, Evanston, Ill (Y.Z., Y.J.); Dept of Radiology, Univ of Wisconsin-Madison, Madison, Wis (E.S.B.); Lineberger Comprehensive Cancer Ctr, Univ of North Carolina, Chapel Hill, NC (K.A.H., C.F., C.M.P.); Dept of Medicine, Section of Hematology & Oncology, The Univ of Chicago, Chicago, Ill (S.D.C.); Dept of Diagnostic Radiology, The Univ of Texas MD Anderson Cancer Ctr, Houston, Tex (G.J.W.); Dept of Radiology, Memorial Sloan-Kettering Cancer Ctr, New York, NY (E.J.S., E.A.M.); Dept of Radiology, Univ of Miami Sylvester Comprehensive Cancer Ctr, Miami, Fla (J.M.N.); Dept of Radiology, Univ of Pittsburgh Medical Ctr, Pittsburgh, Pa (M.G.); and Div of Cancer Treatment and Diagnosis, National Cancer Inst, Biometric Research Branch, Bethesda, Md (E.H.).
authors.forename: Elizabeth J
authors.initials: EJ
authors.lastname: Sutton
authors.affiliation: From the Depts of Radiology (H.L., K.D., M.L.G.) and Public Health Sciences (Y.J.), The Univ of Chicago, 5841 S Maryland Ave, MC 2026, Chicago, IL 60637; Program of Computational Genomics & Medicine, NorthShore Univ HealthSystem, Evanston, Ill (Y.Z., Y.J.); Dept of Radiology, Univ of Wisconsin-Madison, Madison, Wis (E.S.B.); Lineberger Comprehensive Cancer Ctr, Univ of North Carolina, Chapel Hill, NC (K.A.H., C.F., C.M.P.); Dept of Medicine, Section of Hematology & Oncology, The Univ of Chicago, Chicago, Ill (S.D.C.); Dept of Diagnostic Radiology, The Univ of Texas MD Anderson Cancer Ctr, Houston, Tex (G.J.W.); Dept of Radiology, Memorial Sloan-Kettering Cancer Ctr, New York, NY (E.J.S., E.A.M.); Dept of Radiology, Univ of Miami Sylvester Comprehensive Cancer Ctr, Miami, Fla (J.M.N.); Dept of Radiology, Univ of Pittsburgh Medical Ctr, Pittsburgh, Pa (M.G.); and Div of Cancer Treatment and Diagnosis, National Cancer Inst, Biometric Research Branch, Bethesda, Md (E.H.).
authors.forename: Jose M
authors.initials: JM
authors.lastname: Net
authors.affiliation: From the Depts of Radiology (H.L., K.D., M.L.G.) and Public Health Sciences (Y.J.), The Univ of Chicago, 5841 S Maryland Ave, MC 2026, Chicago, IL 60637; Program of Computational Genomics & Medicine, NorthShore Univ HealthSystem, Evanston, Ill (Y.Z., Y.J.); Dept of Radiology, Univ of Wisconsin-Madison, Madison, Wis (E.S.B.); Lineberger Comprehensive Cancer Ctr, Univ of North Carolina, Chapel Hill, NC (K.A.H., C.F., C.M.P.); Dept of Medicine, Section of Hematology & Oncology, The Univ of Chicago, Chicago, Ill (S.D.C.); Dept of Diagnostic Radiology, The Univ of Texas MD Anderson Cancer Ctr, Houston, Tex (G.J.W.); Dept of Radiology, Memorial Sloan-Kettering Cancer Ctr, New York, NY (E.J.S., E.A.M.); Dept of Radiology, Univ of Miami Sylvester Comprehensive Cancer Ctr, Miami, Fla (J.M.N.); Dept of Radiology, Univ of Pittsburgh Medical Ctr, Pittsburgh, Pa (M.G.); and Div of Cancer Treatment and Diagnosis, National Cancer Inst, Biometric Research Branch, Bethesda, Md (E.H.).
authors.forename: Marie
authors.initials: M
authors.lastname: Ganott
authors.affiliation: From the Depts of Radiology (H.L., K.D., M.L.G.) and Public Health Sciences (Y.J.), The Univ of Chicago, 5841 S Maryland Ave, MC 2026, Chicago, IL 60637; Program of Computational Genomics & Medicine, NorthShore Univ HealthSystem, Evanston, Ill (Y.Z., Y.J.); Dept of Radiology, Univ of Wisconsin-Madison, Madison, Wis (E.S.B.); Lineberger Comprehensive Cancer Ctr, Univ of North Carolina, Chapel Hill, NC (K.A.H., C.F., C.M.P.); Dept of Medicine, Section of Hematology & Oncology, The Univ of Chicago, Chicago, Ill (S.D.C.); Dept of Diagnostic Radiology, The Univ of Texas MD Anderson Cancer Ctr, Houston, Tex (G.J.W.); Dept of Radiology, Memorial Sloan-Kettering Cancer Ctr, New York, NY (E.J.S., E.A.M.); Dept of Radiology, Univ of Miami Sylvester Comprehensive Cancer Ctr, Miami, Fla (J.M.N.); Dept of Radiology, Univ of Pittsburgh Medical Ctr, Pittsburgh, Pa (M.G.); and Div of Cancer Treatment and Diagnosis, National Cancer Inst, Biometric Research Branch, Bethesda, Md (E.H.).
authors.forename: Erich
authors.initials: E
authors.lastname: Huang
authors.affiliation: From the Depts of Radiology (H.L., K.D., M.L.G.) and Public Health Sciences (Y.J.), The Univ of Chicago, 5841 S Maryland Ave, MC 2026, Chicago, IL 60637; Program of Computational Genomics & Medicine, NorthShore Univ HealthSystem, Evanston, Ill (Y.Z., Y.J.); Dept of Radiology, Univ of Wisconsin-Madison, Madison, Wis (E.S.B.); Lineberger Comprehensive Cancer Ctr, Univ of North Carolina, Chapel Hill, NC (K.A.H., C.F., C.M.P.); Dept of Medicine, Section of Hematology & Oncology, The Univ of Chicago, Chicago, Ill (S.D.C.); Dept of Diagnostic Radiology, The Univ of Texas MD Anderson Cancer Ctr, Houston, Tex (G.J.W.); Dept of Radiology, Memorial Sloan-Kettering Cancer Ctr, New York, NY (E.J.S., E.A.M.); Dept of Radiology, Univ of Miami Sylvester Comprehensive Cancer Ctr, Miami, Fla (J.M.N.); Dept of Radiology, Univ of Pittsburgh Medical Ctr, Pittsburgh, Pa (M.G.); and Div of Cancer Treatment and Diagnosis, National Cancer Inst, Biometric Research Branch, Bethesda, Md (E.H.).
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Morris
authors.affiliation: From the Depts of Radiology (H.L., K.D., M.L.G.) and Public Health Sciences (Y.J.), The Univ of Chicago, 5841 S Maryland Ave, MC 2026, Chicago, IL 60637; Program of Computational Genomics & Medicine, NorthShore Univ HealthSystem, Evanston, Ill (Y.Z., Y.J.); Dept of Radiology, Univ of Wisconsin-Madison, Madison, Wis (E.S.B.); Lineberger Comprehensive Cancer Ctr, Univ of North Carolina, Chapel Hill, NC (K.A.H., C.F., C.M.P.); Dept of Medicine, Section of Hematology & Oncology, The Univ of Chicago, Chicago, Ill (S.D.C.); Dept of Diagnostic Radiology, The Univ of Texas MD Anderson Cancer Ctr, Houston, Tex (G.J.W.); Dept of Radiology, Memorial Sloan-Kettering Cancer Ctr, New York, NY (E.J.S., E.A.M.); Dept of Radiology, Univ of Miami Sylvester Comprehensive Cancer Ctr, Miami, Fla (J.M.N.); Dept of Radiology, Univ of Pittsburgh Medical Ctr, Pittsburgh, Pa (M.G.); and Div of Cancer Treatment and Diagnosis, National Cancer Inst, Biometric Research Branch, Bethesda, Md (E.H.).
authors.forename: Charles M
authors.initials: CM
authors.lastname: Perou
authors.affiliation: From the Depts of Radiology (H.L., K.D., M.L.G.) and Public Health Sciences (Y.J.), The Univ of Chicago, 5841 S Maryland Ave, MC 2026, Chicago, IL 60637; Program of Computational Genomics & Medicine, NorthShore Univ HealthSystem, Evanston, Ill (Y.Z., Y.J.); Dept of Radiology, Univ of Wisconsin-Madison, Madison, Wis (E.S.B.); Lineberger Comprehensive Cancer Ctr, Univ of North Carolina, Chapel Hill, NC (K.A.H., C.F., C.M.P.); Dept of Medicine, Section of Hematology & Oncology, The Univ of Chicago, Chicago, Ill (S.D.C.); Dept of Diagnostic Radiology, The Univ of Texas MD Anderson Cancer Ctr, Houston, Tex (G.J.W.); Dept of Radiology, Memorial Sloan-Kettering Cancer Ctr, New York, NY (E.J.S., E.A.M.); Dept of Radiology, Univ of Miami Sylvester Comprehensive Cancer Ctr, Miami, Fla (J.M.N.); Dept of Radiology, Univ of Pittsburgh Medical Ctr, Pittsburgh, Pa (M.G.); and Div of Cancer Treatment and Diagnosis, National Cancer Inst, Biometric Research Branch, Bethesda, Md (E.H.).
authors.forename: Yuan
authors.initials: Y
authors.lastname: Ji
authors.affiliation: From the Depts of Radiology (H.L., K.D., M.L.G.) and Public Health Sciences (Y.J.), The Univ of Chicago, 5841 S Maryland Ave, MC 2026, Chicago, IL 60637; Program of Computational Genomics & Medicine, NorthShore Univ HealthSystem, Evanston, Ill (Y.Z., Y.J.); Dept of Radiology, Univ of Wisconsin-Madison, Madison, Wis (E.S.B.); Lineberger Comprehensive Cancer Ctr, Univ of North Carolina, Chapel Hill, NC (K.A.H., C.F., C.M.P.); Dept of Medicine, Section of Hematology & Oncology, The Univ of Chicago, Chicago, Ill (S.D.C.); Dept of Diagnostic Radiology, The Univ of Texas MD Anderson Cancer Ctr, Houston, Tex (G.J.W.); Dept of Radiology, Memorial Sloan-Kettering Cancer Ctr, New York, NY (E.J.S., E.A.M.); Dept of Radiology, Univ of Miami Sylvester Comprehensive Cancer Ctr, Miami, Fla (J.M.N.); Dept of Radiology, Univ of Pittsburgh Medical Ctr, Pittsburgh, Pa (M.G.); and Div of Cancer Treatment and Diagnosis, National Cancer Inst, Biometric Research Branch, Bethesda, Md (E.H.).
authors.forename: Maryellen L
authors.initials: ML
authors.lastname: Giger
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000032:analysis; D001943:Breast Neoplasms / Q000235:genetics* / Q000473:pathology*; D005260:Female; D015870:Gene Expression; D023281:Genomics / Q000379:methods*; D006801:Humans; D007089:Image Enhancement; D007090:Image Interpretation, Computer-Assisted; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000235:genetics* / Q000473:pathology*; D010641:Phenotype; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018570:Risk Assessment
chemical_list: D014408:Biomarkers, Tumor