Prognostic value and molecular correlates of a CT image-based quantitative pleural contact index in early stage NSCLC
To evaluate the prognostic value and molecular basis of a CT-derived pleural contact index (PCI) in early stage non-small cell lung cancer (NSCLC).
We retrospectively analysed seven NSCLC cohorts. A quantitative PCI was defined on CT as the length of tumour-pleura interface normalised by tumour diameter. We evaluated the prognostic value of PCI in a discovery cohort (n = 117) and tested in an external cohort (n = 88) of stage I NSCLC. Additionally, we identified the molecular correlates and built a gene expression-based surrogate of PCI using another cohort of 89 patients. To further evaluate the prognostic relevance, we used four datasets totalling 775 stage I patients with publically available gene expression data and linked survival information.
At a cutoff of 0.8, PCI stratified patients for overall survival in both imaging cohorts (log-rank p = 0.0076, 0.0304). Extracellular matrix (ECM) remodelling was enriched among genes associated with PCI (p = 0.0003). The genomic surrogate of PCI remained an independent predictor of overall survival in the gene expression cohorts (hazard ratio: 1.46, p = 0.0007) adjusting for age, gender, and tumour stage.
CT-derived pleural contact index is associated with ECM remodelling and may serve as a noninvasive prognostic marker in early stage NSCLC.
• A quantitative pleural contact index (PCI) predicts survival in early stage NSCLC.
• PCI is associated with extracellular matrix organisation and collagen catabolic process.
• A multi-gene surrogate of PCI is an independent predictor of survival.
• PCI can be used to noninvasively identify patients with poor prognosis.
KeywordsPleural contact Lung cancer Prognosis Imaging biomarker Radiogenomics
Compliance with ethical standards
The scientific guarantor of this publication is Ruijiang Li.
Conflict of interest
The authors have no potential conflicts of interest.
This research was partially supported by the NIH grant number R00 CA166186, R01 CA193730.
Statistics and biometry
No complex statistical methods were necessary for this paper.
Written informed consent was waived by the Institutional Review Board.
Institutional Review Board approval was obtained.
• cross-sectional study
• multicentre study
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