Radiomics-based predictive risk score: A scoring system for preoperatively predicting risk of lymph node metastasis in patients with resectable non-small cell lung cancer.

Lan He,Zaiyi Liu,Lixu Yan,Changhong Liang,Junhui Zheng,Yanqi Huang

doi:10.21147/j.issn.1000-9604.2019.04.08

Abstract

ObjectiveTo develop and validate a radiomics-based predictive risk score (RPRS) for preoperative prediction of lymph node (LN) metastasis in patients with resectable non-small cell lung cancer (NSCLC).MethodsWe retrospectively analyzed 717 who underwent surgical resection for primary NSCLC with systematic mediastinal lymphadenectomy from October 2007 to July 2016. By using the method of radiomics analysis, 591 computed tomography (CT)-based radiomics features were extracted, and the radiomics-based classifier was constructed. Then, using multivariable logistic regression analysis, a weighted score RPRS was derived to identify LN metastasis. Apparent prediction performance of RPRS was assessed with its calibration, discrimination, and clinical usefulness.ResultsThe radiomics-based classifier was constructed, which consisted of 13 selected radiomics features. Multivariate models demonstrated that radiomics-based classifier, age group, tumor diameter, tumor location, and CT-based LN status were independent predictors. When we assigned the corresponding score to each variable, patients with RPRSs of 0−3, 4−5, 6, 7−8, and 9 had distinctly very low (0%−20%), low (21%−40%), intermediate (41%−60%), high (61%−80%), and very high (81%−100%) risks of LN involvement, respectively. The developed RPRS showed good discrimination and satisfactory calibration [C-index: 0.785, 95% confidence interval (95% CI): 0.780−0.790]. Additionally, RPRS outperformed the clinicopathologic-based characteristics model with net reclassification index (NRI) of 0.711 (95% CI: 0.555−0.867).ConclusionsThe novel clinical scoring system developed as RPRS can serve as an easy-to-use tool to facilitate the preoperatively individualized prediction of LN metastasis in patients with resectable NSCLC. This stratification of patients according to their LN status may provide a basis for individualized treatment.

Highlights

Lung cancer is the leading cause of cancer-related mortality worldwide, with non-small cell lung cancer (NSCLC) accounting for approximately 85% of such deaths [1,2].Precise staging is the key to appropriate prognosis and treatment strategy decision [3]
Patients who had negative nodes by complete mediastinal lymph node (LN) dissection did not have improved survival compared with systematic LN sampling [6,7], and patients with positive LN involvement have a higher risk of disease recurrence
CT, computed tomography; LN, lymph node; RPRS, radiomics-based predictive risk score; OR, odds ratio; 95% CI, 95% confidence interval; NA, not applicable

Summary

Introduction

Precise staging is the key to appropriate prognosis and treatment strategy decision [3]. For patients with resectable (stage I−IIIA) NSCLC, surgical resection remains the primary and preferred approach to the treatment with the www.cjcrcn.org. As recommended by National Comprehensive Cancer Network (NCCN) guidelines, patients with resectable NSCLC should receive N1 and N2 node resection and a minimum of 3 N2 stations sampled or complete lymph node (LN) dissection during pulmonary resection [5]. Patients who had negative nodes by complete mediastinal LN dissection did not have improved survival compared with systematic LN sampling [6,7], and patients with positive LN involvement have a higher risk of disease recurrence.

Methods

Results

Conclusion