Radiomic signature accurately predicts the risk of metastatic dissemination in late-stage non-small cell lung cancer

Background Non-small cell lung cancer (NSCLC) is the most common type of lung cancer, and the median overall survival is approximately 2-3 years among patients with stage III disease. Furthermore, it is one of the deadliest types of cancer globally due to non-specific symptoms and the lack of a biomarker for early detection. The most important decision that clinicians need to make after a lung cancer diagnosis is the selection of a treatment schedule. This decision is based on, among others factors, the risk of developing metastasis. Methods A cohort of 115 NSCLC patients treated using chemotherapy and radiotherapy with curative intent was retrospectively collated and included patients for whom positron emission tomogra-phy/computed tomography (PET/CT) images, acquired before radiotherapy, were available. The PET/CT images were used to compute radiomic features extracted from a region of interest, the primary tumor. Radiomic and clinical features were then classified to stratify the patients into short and long time to metastasis, and regression analysis was used to predict the risk of metastasis. Results Classification based on binarized metastasis-free survival (MFS) was applied with moderate success. Indeed, an accuracy of 0.73 was obtained for the selection of features based on the Wilcoxon test and logistic regression model. However, the Cox regression model for metastasis risk prediction performed very well, with a concordance index (c-index) score equal to 0.84. Conclusions It is possible to accurately predict the risk of metastasis in NSCLC patients based on radiomic features. The results demonstrate the potential use of features extracted from cancer imaging in predicting the risk of metastasis. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This work was supported by the Polish National Science Centre, Grant Number: UMO-2020/37/B/ST6/01959, and Silesian University of Technology statutory research funds. Calcu-lations were performed on the Ziemowit computer cluster in the Laboratory of Bioinformatics and Computational Biology, created in the EU Innovative Economy Programme POIG.02.01.00-00-166/08 and expanded in the POIG.02.03.01-00-040/13 project. Data analy-sis was partially carried out using the Biotest Platform developed within project PBS3/B3/32/2015, which was financed by the Polish National Centre of Research and Devel-opment (NCBiR). This work was carried out in part by the Silesian University of Technology internal research funding (A.M.W., E.K., D.B., K.F., J.S., and A.S.). The founders have no role in designing the study and writing the manuscript. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The authors are accountable for all aspects of the work and will ensure that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. The study was conducted in accordance with the Declaration of Helsinki (as revised in 2013). The study was approved by the institutional board of Maria Skłodowska-Curie National Research Institute of Oncology (Gliwice Branch), and individual consent for this retrospective analysis was waived. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors