Abstract
Background Radiomics-based biomarkers enable the prognostication of resected non-small cell lung cancer (NSCLC), but their effectiveness in clinical stage and pathologic stage IA pure-solid tumors requires further determination. Purpose To construct an efficient radiomics signature for survival risk stratification personalized for patients with clinical stage and pathologic stage IA pure-solid NSCLC. Materials and Methods In this retrospective study, six radiomics signatures were constructed for patients with stage IA pure-solid NSCLC who underwent resection between January 2011 and December 2013 at authors' institution and were tested in the radiogenomics data set. The radiomics features were extracted from the intratumoral two-dimensional region, three-dimensional volume, and peritumoral area using PyRadiomics. The discriminative abilities of the signatures were quantified using the area under the time-dependent receiver operating characteristic curve (AUC), and the optimal signature was selected for patient stratification. Results The study included 592 patients with stage IA pure-solid NSCLC (median age, 61 years; interquartile range, 55-66 years; 269 women) for radiomics analysis: 381 patients for training, 163 for internal validation, and 48 for external validation. The radiomics signature combining three-region features yielded the highest 3- and 5-year AUCs of 0.77 and 0.78, respectively, in the internal validation set and 0.76 and 0.75, respectively, in the external validation set. Multivariable analysis suggested that the radiomics signature remained an independent prognostic factor (hazard ratio, 6.2; 95% CI: 3.5, 11.0; P < .001) and improved the discriminative ability and clinical usefulness of conventional clinical predictors. Conclusion The radiomics signature with multiregional features helped stratify the survival risk of patients with clinical stage and pathologic stage IA pure-solid non-small cell lung cancer. Published under a CC BY 4.0 license. Online supplemental material is available for this article. See also the editorial by Hsu and Sohn in this issue.
Highlights
D pure-solid nodules [13,14,15]
Accumulated evidence suggests that subsolid nodules, including both pure ground-glass opacity nodules and part-solid nodules with coexisting ground-glass opacity and solid components, are associated with favorable survival outcomes, despite the size of the solid component and clinical stage [2,3,4]
Radiologic pure-solid nodules have a rate of occult lymph node metastasis ranging from 11% to 24%, even after standard surgical procedures, and exhibit more malignant behaviors and poorer prognoses than subsolid nodules [5,6]
Summary
Its successful application in these patients may be attributed to easy identification of the ground-glass opacity pattern, which is an established main prognostic feature. Our previous works suggest that radiomics could serve as a prognostic marker personalized for patients with pure-solid tumors, but this finding requires further validation [16,17]. Radiomics features quantifying the peritumoral tissues were related to spread through air spaces [18] and lymph node metastasis in early stage NSCLC [11]. The prognostic evaluation of these radiomics features that characterize the microenvironment invasion of the tumor periphery should be emphasized [19].
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