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).

Experimental design

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.

Key points

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.

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Corresponding author

Correspondence to Ruijiang Li.

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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.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.


• retrospective

• cross-sectional study

• multicentre study

Additional information

Juheon Lee and Yi Cui contributed equally to the work.

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Lee, J., Cui, Y., Sun, X. et al. Prognostic value and molecular correlates of a CT image-based quantitative pleural contact index in early stage NSCLC. Eur Radiol 28, 736–746 (2018).

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  • Pleural contact
  • Lung cancer
  • Prognosis
  • Imaging biomarker
  • Radiogenomics