Radiomics Analysis of (18)F-FDG PET/CT for Prognosis Prediction in Patients with Stage III Non-Small Cell Lung Cancer Undergoing Neoadjuvant Chemoradiation Therapy Followed by Surgery

SIMPLE SUMMARY: The estimation of overall survival (OS) in patients with stage III non-small cell lung cancer (NSCLC) is very important for determining a precise therapeutic strategy. Radiomics is a promising method to extract features that can reflect distinct differences in tumor phenotype from image data. We evaluated the prognostic impact of the radiomic features from (18)F-FDG PET/CT to predict OS in patients with stage III NSCLC undergoing neoadjuvant concurrent chemoradiation therapy (CCRT) followed by surgery and compared the predictive performance of radiomics versus conventional PET parameters. We demonstrated that radiomic features using (18)F-FDG PET/CT could be robust and useful in assessing the survival rate. Furthermore, this study demonstrated the important prognostic implications of radiomics in (18)F-FDG PET/CT after neoadjuvant CCRT as well as pretreatment examination. The newly developed LASSO score using radiomic features performs better for individualized OS estimation than conventional PET parameters. ABSTRACT: We investigated the prognostic significance of radiomic features from (18)F-FDG PET/CT to predict overall survival (OS) in patients with stage III NSCLC undergoing neoadjuvant chemoradiation therapy followed by surgery. We enrolled 300 patients with stage III NSCLC who underwent PET/CT at the initial work-up (PET1) and after neoadjuvant concurrent chemoradiotherapy (PET2). Radiomic primary tumor features were subjected to LASSO regression to select the most useful prognostic features of OS. The prognostic significance of the LASSO score and conventional PET parameters was assessed by Cox proportional hazards regression analysis. In conventional PET parameters, metabolic tumor volume (MTV) and total lesion glycolysis (TLG) of each PET1 and PET2 were significantly associated with OS. In addition, both the PET1-LASSO score and the PET2-LASSO score were significantly associated with OS. In multivariate Cox regression analysis, only the PET2-LASSO score was an independently significant factor for OS. The LASSO score showed better predictive performance for OS regarding the time-dependent receiver operating characteristic curve and decision curve analysis than conventional PET parameters. Radiomic features from PET/CT were an independent prognostic factor for the estimation of OS in stage III NSCLC. The newly developed LASSO score using radiomic features showed better prognostic results for individualized OS estimation than conventional PET parameters.