Prognostic value of (18)F-FDG PET/CT radiomic model based on primary tumor in patients with non-small cell lung cancer: A large single-center cohort study

OBJECTIVES: In the present study, we aimed to determine the prognostic value of the (18)F-FDG PET/CT-based radiomics model when predicting progression-free survival (PFS) and overall survival (OS) in patients with non-small cell lung cancer (NSCLC). METHODS: A total of 368 NSCLC patients who underwent (18)F-FDG PET/CT before treatment were randomly assigned to the training (n = 257) and validation (n = 111) cohorts. Radiomics signatures from PET and CT images were obtained using LIFEx software, and then clinical and complex models were constructed and validated by selecting optimal parameters based on PFS and OS to construct radiomics signatures. RESULTS: In the training cohort, the C-index of the clinical model for predicting PFS and OS in NSCLC patients was 0.748 and 0.834, respectively, and the AUC values ​​were 0.758 and 0.846, respectively. The C-index of the complex model for predicting PFS and OS was 0.775 and 0.881, respectively, and the AUC values ​​were 0.780 and 0.891, respectively. The C-index of the clinical model for predicting PFS and OS in the validation group was 0.729 and 0.832, respectively, and the AUC values ​​were 0.776 and 0.850, respectively. The C-index of the complex model for predicting PFS and OS was 0.755 and 0.867, respectively, and the AUC values ​​were 0.791 and 0.874, respectively. Moreover, decision curve analysis showed that the complex model had a higher net benefit than the clinical model. CONCLUSIONS: (18)F-FDG PET/CT radiomics before treatment could predict PFS and OS in NSCLC patients, and the predictive power was higher when combined with clinical factors.