PURPOSE: The purpose of this study was to explore the potential value of the radiomics model based on dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI), compared with the clinical model mostly based on the epidermal growth factor receptor (EGFR) expression, in predicting progression-free survival (PFS) in patients with locally advanced nasopharyngeal carcinoma (LA-NPC) treated with nimotuzumab (NTZ). METHODS: A total of 136 patients with LA-NPC who received NTZ treatment between January 2018 and June 2022 were included in this study. Patients were randomly divided into training (n = 95) and validation (n = 41) groups in a 7:3 ratio. DCE-MRI radiomics, clinical, and clinical-radiomics models were built to predict PFS. The relationship between EGFR expression levels and NTZ efficacy was assessed using Kaplan-Meier curves. Model performance was assessed using the area under the curve, calibration, and DeLong tests. Decision curve analysis evaluated net clinical benefit. Patients were stratified into high- and low-risk groups based on optimal model radiomic scores, and prognoses were compared using Kaplan-Meier curves. RESULTS: Univariate Cox regression analysis demonstrated that EGFR expression level was the only independent predictive factor of PFS (p <
0.05). Patients with EGFR 3+ receiving NTZ therapy had significantly longer PFS than those with EGFR 1+ (hazard ratio = 3.025, p <
0.05). The clinical-radiomics model exhibited superior predictive efficacy, compared with the radiomics and clinical models (training set: 0.887 vs. 0.845, 0.654
validation set: 0.831, 0.824 vs. 0.567, all p <
0.001). CONCLUSIONS: The clinical-radiomics models using DCE-MRI and EGFR levels can effectively predict NTZ efficacy in LA-NPC patients, providing objective evidence for personalized treatment adjustments. KEY POINTS: Question How can the response to nimotuzumab treatment in patients with locally advanced nasopharyngeal carcinoma be accurately predicted using non-invasive imaging methods? Findings A combined clinical and radiomic model using dynamic contrast-enhanced magnetic resonance imaging showed improved predictive performance for progression-free survival in patients treated with nimotuzumab. Clinical relevance The study provides evidence for using a combined clinical and radiomic approach, offering a non-invasive method to predict treatment response and guide personalized treatment strategies for patients with locally advanced nasopharyngeal carcinoma, potentially improving patient outcomes.