Table 8_Machine learning-based integration of DCE-MRI radiomics for STAT3 expression prediction and survival stratification in breast cancer.docx

Objective<p>To explore the association between signal transducer and activator of transcription 3 (STAT3) expression, tumor immune microenvironment, and overall survival (OS) in breast cancer, and to develop a non-invasive radiomics model for early risk stratification using dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI).</p>Methods<p>Data from 1,008 patients with breast cancer in The Cancer Genome Atlas were analyzed to evaluate the prognostic significance of STAT3 expression using Kaplan-Meier survival analysis and Cox regression models. Functional enrichment and immune cell infiltration analyses were performed to assess tumor immune microenvironment characteristics. Additionally, DCE-MRI data from 101 patients in The Cancer Imaging Archive were used to extract radiomic features from early- and delayed-phase images. A STAT3 predictive model was developed using six machine learning algorithms. Model performance was assessed using receiver operating characteristic (ROC) and related diagnostic statistical indicators.</p>Results<p>Low STAT3 expression was significantly associated with poorer OS (hazard ratio [HR] = 1.927, p < 0.001). GSEA revealed that high STAT3 expression enhanced epithelial apoptosis and TNF-α/NFκB signaling while suppressing pro-tumorigenic pathways, which was associated with an immunosuppressive microenvironment, whereas low STAT3 correlated with T-cell exhaustion. DIA confirmed elevated STAT3 in tumor versus normal tissue (p < 0.05). The logistic regression-derived radiomics model for STAT3 expression prediction exhibited consistent discriminative performance, with area under curve (AUC) values of 0.861 (95% CI: 0.749 - 0.947) in the development cohort and 0.742 (95% CI: 0.588 - 0.884) in the validation cohort. High radiomics-derived scores were positively correlated with elevated STAT3 expression, longer OS (p = 0.034), and immune-related gene signatures indicative of a heightened immune response.</p>Conclusion<p>Radiomics analysis of DCE-MRI images in this study offered a non-invasive method for predicting STAT3 expression and characterization of the tumor immune microenvironment. This approach can offer valuable insights into breast cancer prognosis and support the development of personalized therapies.</p>