Prediction of Occult Lymph Node Metastasis in cN0 Stage Non-Small Cell Lung Cancer Using Contrast-Enhanced CT.

Abstract

Objective: To explore the value of contrast-enhanced CT radiomics in predicting occult lymph node metastasis (OLNM) in patients with clinical N0 (cN0) stage non-small cell lung cancer (NSCLC) prior to surgery.

Study design: Descriptive study. Place and Duration of the Study: Department of Radiology, Guangzhou First People's Hospital, Guangzhou, Guangdong, China, from January 2023 to November 2024.

Methodology: A total of 290 NSCLC patients from two hospitals were divided into training and validation sets. Radiomics features were extracted from the tumour volume of interest, and optimal features were selected in the training set to develop a radiomic signature. Univariate and multivariate logistic regression analyses identified clinical characteristics associated with OLNM, leading to the creation of a clinical model. A combined model was developed by integrating the radiomics signature with clinical features. Model performance was assessed using the area under the ROC curve (AUC), with validation conducted in the independent validation set.  Results: Three radiomics features and two clinical characteristics associated with OLNM were identified (p <0.05). The AUCs of the clinical model, radiomic signature, and combined model in the training and validation sets were 0.746, 0.809, 0.838, 0.708, 0.802, and 0.823, respectively, with the combined model showing the highest AUC in both sets.

Conclusion: The combined model, integrating preoperative CT radiomics features and clinical characteristics, effectively predicts OLNM in cN0 stage NSCLC patients, aiding personalised clinical decision-making and improving prognosis.

Key words: Non-small cell lung cancer, Occult lymph node metastasis, Radiomics.