A combined model was established based on the MRI-radiomics of pre- and mid-treatment to assess the risk of disease progression or death in locally advanced nasopharyngeal carcinoma.A total of 243 patients were analyzed. We extracted 10,400 radiomics features from the primary nasopharyngeal tumors and largest metastatic lymph nodes on the axial contrast-enhanced T1 weighted and T2 weighted in pre- and mid-treatment MRI, respectively. We used the SMOTE algorithm, center and scale and box-cox, Pearson correlation coefficient, and LASSO regression to construct the pre- and mid-treatment MRI-radiomics prediction model, respectively, and the risk scores named P score and M score were calculated. Finally, univariate and multivariate analyses were used for P score, M score, and clinical data to build the combined model and grouped the patients into two risk levels, namely, high and low.A combined model of pre- and mid-treatment MRI-radiomics successfully categorized patients into high- and low-risk groups. The log-rank test showed that the high- and low-risk groups had good prognostic performance in PFS (P<0.0001, HR: 19.71, 95% CI: 12.77-30.41), which was better than TNM stage (P=0.004, HR:1.913, 95% CI:1.250-2.926), and also had an excellent predictive effect in LRFS, DMFS, and OS.Risk grouping of LA-NPC using a combined model of pre- and mid-treatment MRI-radiomics can better predict disease progression or death.Copyright © 2021 Kang, Niu, Huang, Lin, Tang, Chen, Fan, Lang, Yin and Zhang.