Department of Radiation Oncology, National Clinical Research Center for Cancer/Cancer Hospital/National Cancer Center, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Department of VIP Medical Services, National Clinical Research Center for Cancer/Cancer Hospital/National Cancer Center, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Cancer Imaging. 2024 May 13;24(1):61. doi: 10.1186/s40644-024-00707-6.
BACKGROUND: The value of postoperative radiotherapy (PORT) for patients with non-small cell lung cancer (NSCLC) remains controversial. A subset of patients may benefit from PORT. We aimed to identify patients with NSCLC who could benefit from PORT. METHODS: Patients from cohorts 1 and 2 with pathological Tany N2 M0 NSCLC were included, as well as patients with non-metastatic NSCLC from cohorts 3 to 6. The radiomic prognostic index (RPI) was developed using radiomic texture features extracted from the primary lung nodule in preoperative chest CT scans in cohort 1 and validated in other cohorts. We employed a least absolute shrinkage and selection operator-Cox regularisation model for data dimension reduction, feature selection, and the construction of the RPI. We created a lymph-radiomic prognostic index (LRPI) by combining RPI and positive lymph node number (PLN). We compared the outcomes of patients who received PORT against those who did not in the subgroups determined by the LRPI. RESULTS: In total, 228, 1003, 144, 422, 19, and 21 patients were eligible in cohorts 1-6. RPI predicted overall survival (OS) in all six cohorts: cohort 1 (HR = 2.31, 95% CI: 1.18-4.52), cohort 2 (HR = 1.64, 95% CI: 1.26-2.14), cohort 3 (HR = 2.53, 95% CI: 1.45-4.3), cohort 4 (HR = 1.24, 95% CI: 1.01-1.52), cohort 5 (HR = 2.56, 95% CI: 0.73-9.02), cohort 6 (HR = 2.30, 95% CI: 0.53-10.03). LRPI predicted OS (C-index: 0.68, 95% CI: 0.60-0.75) better than the pT stage (C-index: 0.57, 95% CI: 0.50-0.63), pT + PLN (C-index: 0.58, 95% CI: 0.46-0.70), and RPI (C-index: 0.65, 95% CI: 0.54-0.75). The LRPI was used to categorize individuals into three risk groups; patients in the moderate-risk group benefited from PORT (HR = 0.60, 95% CI: 0.40-0.91; p = 0.02), while patients in the low-risk and high-risk groups did not. CONCLUSIONS: We developed preoperative CT-based radiomic and lymph-radiomic prognostic indexes capable of predicting OS and the benefits of PORT for patients with NSCLC.
背景:非小细胞肺癌(NSCLC)患者术后放疗(PORT)的价值仍存在争议。一部分患者可能从中获益。我们旨在确定可从 PORT 中获益的 NSCLC 患者。
方法:纳入队列 1 和 2 中病理 Tany N2 M0 NSCLC 患者,以及队列 3 至 6 中无远处转移 NSCLC 患者。在队列 1 中使用术前胸部 CT 扫描中从原发肺结节提取的放射组学预后指数(RPI)进行放射组学特征开发,并在其他队列中进行验证。我们采用最小绝对收缩和选择算子-Cox 正则化模型进行数据降维、特征选择和 RPI 的构建。我们通过将 RPI 与阳性淋巴结数(PLN)相结合,创建了淋巴放射组学预后指数(LRPI)。我们根据 LRPI 确定的亚组比较了接受 PORT 和未接受 PORT 的患者的结局。
结果:队列 1-6 中分别有 228、1003、144、422、19 和 21 名患者符合条件。RPI 可预测所有 6 个队列的总生存期(OS):队列 1(HR=2.31,95%CI:1.18-4.52),队列 2(HR=1.64,95%CI:1.26-2.14),队列 3(HR=2.53,95%CI:1.45-4.3),队列 4(HR=1.24,95%CI:1.01-1.52),队列 5(HR=2.56,95%CI:0.73-9.02),队列 6(HR=2.30,95%CI:0.53-10.03)。LRPI 预测 OS(C 指数:0.68,95%CI:0.60-0.75)优于 pT 分期(C 指数:0.57,95%CI:0.50-0.63)、pT+PLN(C 指数:0.58,95%CI:0.46-0.70)和 RPI(C 指数:0.65,95%CI:0.54-0.75)。LRPI 将个体分为三个风险组;中危组患者从 PORT 中获益(HR=0.60,95%CI:0.40-0.91;p=0.02),而低危组和高危组患者未获益。
结论:我们开发了术前 CT 基于放射组学和淋巴放射组学的预后指数,能够预测 NSCLC 患者的 OS 和 PORT 的获益。
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