In advanced larynx cancer, the use of induction chemotherapy (IC) to select patients for organ preservation offers outcomes comparable to upfront laryngectomy. Assessment of tumor response to IC is performed with direct laryngoscopy (DL), and barriers to this approach exist. In this study, we retrospectively investigate radiomic and clinical features as predictors of OS and laryngectomy free survival (LFS). Larynx cancer patients from a single institution with usable CT and PET scans were included. Clinical variables investigated were tumor subsite, T-stage, N-stage, neutrophil-lymphocyte ratio (NLR), and lymphocyte-monocyte ratio (LMR). CT-based variables were pre-IC GTV, GTV change between pre and post IC (ΔGTV), and 43 radiomic texture features. Cox proportional hazards was utilized for OS and LFS; logistic regression was used for IC response. Feature selection for each model was performed by identifying variables with a significant (p ≤ 0.05) Spearman rank. Model accuracy was assessed using the average concordance index from 100 iterations of stratified, 5-fold cross validation. Of 84 patents with CT, and clinical features, 5 features were found to have significant correlations with surgeon-assessed IC response: 3 texture-based radiomic features (coarseness, busyness, grey level nonuniformity (GLN)), ΔGTV, and N-stage. The latter 3 features contributed significantly to the final model (see table). For OS, only N-stage had significant correlation. For LFS, 8 features were found to have significant correlations, including 5 texture features (coarseness, busyness, strength, grey level variance (GLV), large zone emphasis (LZE)), NLR, LMR, and ΔGTV. Of these 8 features, 2 contributed significantly to the final model (see table). When including PET features for 54 patients, only LFS was found to correlate significantly with PET-based features. Of 12 features found to have significant correlation with LFS, 5 contributed significantly to the final model: PET contrast (hazard ratio (HR) = 1.70, p = 0.02), PET correlation (HR = 3790, p = 0.03), PET dissimilarity (HR = 1.20E-05, p = 0.048), ΔGTV (HR = 0.959, p = 0.001), and NLR (HR = 3.67, p = 0.04). The average concordance index for this model was 0.628 ± 0.149. In this study, we investigate the role of CT-based, PET-based, and clinical features as predictors for OS, LFS, and surgeon-assessed response to IC in a bioselection approach to larynx cancer. Initial results indicate that several features may have value as predictors for OS, LFS, and IC response. Due to limited data size, further studies with larger datasets are necessary to validate these results and further explore the potential of these variables.Tabled 1Abstract 2698; TableModelFeatureHazard/Odds ratiop-valueMean C-idxICGLN0.4750.0280.808 ± 0.099ΔGTV5.23< 0.001N-stage1.860.003OSN-stage1.8740.010.643 ± 0.102LFSΔGTV0.578< 0.001NLR2.740.0050.664 ± 0.101 Open table in a new tab