Abstract
PurposeTo develop and validate a clinico-biological features and 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) radiomic-based nomogram via machine learning for the pretherapy prediction of discriminating between adenocarcinoma (ADC) and squamous cell carcinoma (SCC) in non-small cell lung cancer (NSCLC).MethodsA total of 315 NSCLC patients confirmed by postoperative pathology between January 2017 and June 2019 were retrospectively analyzed and randomly divided into the training (n = 220) and validation (n = 95) sets. Preoperative clinical factors, serum tumor markers, and PET, and CT radiomic features were analyzed. Prediction models were developed using the least absolute shrinkage and selection operator (LASSO) regression analysis. The performance of the models was evaluated and compared by the area under receiver-operator characteristic (ROC) curve (AUC) and DeLong test. The clinical utility of the models was determined via decision curve analysis (DCA). Then, a nomogram was developed based on the model with the best predictive efficiency and clinical utility and was validated using the calibration plots.ResultsIn total, 122 SCC and 193 ADC patients were enrolled in this study. Four independent prediction models were separately developed to differentiate SCC from ADC using clinical factors-tumor markers, PET radiomics, CT radiomics, and their combination. The DeLong test and DCA showed that the Combined Model, consisting of 2 clinical factors, 2 tumor markers, 7 PET radiomics, and 3 CT radiomic parameters, held the highest predictive efficiency and clinical utility in predicting the NSCLC subtypes compared with the use of these parameters alone in both the training and validation sets (AUCs (95% CIs) = 0.932 (0.900–0.964), 0.901 (0.840–0.957), respectively) (p < 0.05). A quantitative nomogram was subsequently constructed using the independently risk factors from the Combined Model. The calibration curves indicated a good consistency between the actual observations and nomogram predictions.ConclusionThis study presents an integrated clinico-biologico-radiological nomogram that can be accurately and noninvasively used for the individualized differentiation SCC from ADC in NSCLC, thereby assisting in clinical decision making for precision treatment.
Highlights
Non-small cell lung cancer (NSCLC) accounts for approximately 85% of lung cancer that is the most common cause of cancer-related mortality worldwide, with an estimated 1.4 million deaths each year [1]
This study presents an integrated clinico-biologico-radiological nomogram that can be accurately and noninvasively used for the individualized differentiation squamous cell carcinoma (SCC) from ADC in NSCLC, thereby assisting in clinical decision making for precision treatment
With advances in targeted therapies, molecularly targeted agents that inhibit epidermal growth factor receptor (EGFR) and anaplastic lymphoma kinase (ALK) can significantly improve the efficacy and reduce the toxicity of NSCLC, as almost all these gene mutations are found in ADC [6, 7]
Summary
Non-small cell lung cancer (NSCLC) accounts for approximately 85% of lung cancer that is the most common cause of cancer-related mortality worldwide, with an estimated 1.4 million deaths each year [1]. Adenocarcinoma (ADC) and squamous cell carcinoma (SCC) are the most common subtypes of NSCLC [2]. Different pathological subtypes have distinct phenotypic and biological characteristics, which are directly related to the clinical treatment and outcome [3,4,5]. Accurately predicting the histological subtypes is essential for determining better therapeutic strategies in NSCLC. An invasive biopsy for histological confirmation is commonly used in clinical practice [8]. It is clinically important and necessary to explore a reliable, noninvasive, and practical method for the pre-therapy prediction of the histologic subtypes for treatment decision making and prognosis estimation in NSCLC patients
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