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Integrative nomogram of CT imaging, clinical, and hematological features for survival prediction of patients with locally advanced non-small cell lung cancer

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Abstract

Objectives

To determine the integrative value of clinical, hematological, and computed tomography (CT) radiomic features in survival prediction for locally advanced non-small cell lung cancer (LA-NSCLC) patients.

Methods

Radiomic features and clinical and hematological features of 118 LA-NSCLC cases were firstly extracted and analyzed in this study. Then, stable and prognostic radiomic features were automatically selected using the consensus clustering method with either Cox proportional hazard (CPH) model or random survival forest (RSF) analysis. Predictive radiomic, clinical, and hematological parameters were subsequently fitted into a final prognostic model using both the CPH model and the RSF model. A multimodality nomogram was then established from the fitting model and was cross-validated. Finally, calibration curves were generated with the predicted versus actual survival status.

Results

Radiomic features selected by clustering combined with CPH were found to be more predictive, with a C-index of 0.699 in comparison to 0.648 by clustering combined with RSF. Based on multivariate CPH model, our integrative nomogram achieved a C-index of 0.792 and retained 0.743 in the cross-validation analysis, outperforming radiomic, clinical, or hematological model alone. The calibration curve showed agreement between predicted and actual values for the 1-year and 2-year survival prediction. Interestingly, the selected important radiomic features were significantly correlated with levels of platelet, platelet/lymphocyte ratio (PLR), and lymphocyte/monocyte ratio (LMR) (p values all < 0.05).

Conclusions

The integrative nomogram incorporated CT radiomic, clinical, and hematological features improved survival prediction in LA-NSCLC patients, which would offer a feasible and practical reference for individualized management of these patients.

Key Points

• An integrative nomogram incorporated CT radiomic, clinical, and hematological features was constructed and cross-validated to predict prognosis of LA-NSCLC patients.

• The integrative nomogram outperformed radiomic, clinical, or hematological model alone.

• This nomogram has value to permit non-invasive, comprehensive, and dynamical evaluation of the phenotypes of LA-NSCLC and can provide a feasible and practical reference for individualized management of LA-NSCLC patients.

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Abbreviations

CCRT:

Concurrent chemotherapy and radiotherapy

C-index:

Concordance index

CPH:

Cox proportional hazard

CT:

Computed tomography

GLCM:

Gray-level co-occurrence matrix

GLSZM:

Gray-level size zone matrix

GTV:

Gross tumor volume

LA-NSCLC:

Locally advanced non-small cell lung cancer

LMR:

Lymphocyte/monocyte ratio

NLR:

Neutrophil/lymphocyte ratio

PLR:

Platelet/lymphocyte ratio

RECIST:

Response Evaluation Criteria in Solid Tumors

RSF:

Random survival forest

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Funding

This work was supported by China Scholarship Fund, the Project of Postdoctoral Science Foundation of China (Grant Nos. 2016M590640 and 2016M592199), the Project of Postdoctoral Innovation of Shandong Province (Grant No. 201501010), National Health and Family Planning Commission of China (201402011), and National Natural Science Foundation of China (81472812).

Author information

Author notes

  1. Linlin Wang and Taotao Dong contributed equally to this work.

Authors and Affiliations

  1. Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Science, No. 440, Ji Yan Road, Jinan, 250017, China

    Linlin Wang, Meiying Guo, Huaqi Zhang & Jinming Yu

  2. Department of Gynecology and Obstetrics, Qilu Hospital of Shandong University, Jinan, China

    Taotao Dong

  3. School of Information Technologies, the University of Sydney, Building J12, Sydney, NSW, 2006, Australia

    Bowen Xin, Chongrui Xu, Dagan Feng & Xiuying Wang

  4. Medical College of Shandong University, Jinan, China

    Meiying Guo

  5. Tianjin Medical University, Tianjin, China

    Huaqi Zhang

Authors
  1. Linlin Wang
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Corresponding authors

Correspondence to Xiuying Wang or Jinming Yu.

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The scientific guarantor of this publication is Jinming Yu.

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The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

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No complex statistical methods were necessary for this paper.

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Written informed consent was waived by the Institutional Review Board.

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Wang, L., Dong, T., Xin, B. et al. Integrative nomogram of CT imaging, clinical, and hematological features for survival prediction of patients with locally advanced non-small cell lung cancer. Eur Radiol 29, 2958–2967 (2019). https://doi.org/10.1007/s00330-018-5949-2

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