Abstract
OBJECTIVE: This study aimed to evaluate the predictive performance of integrated clinical and CT-based radiomic models for assessing targeted therapy efficacy in advanced lung adenocarcinoma patients with EGFR (epidermal growth factor receptor) mutations. MATERIALS AND METHODS: This retrospective study included 106 EGFR-mutated advanced lung adenocarcinoma patients treated with targeted therapies at the Second Hospital of Jilin University (2020-2023). Patients were classified as responders (PR) or non-responders (SD/PD) based on RECIST (Response Evaluation Criteria in Solid Tumors) 1.1 criteria, then randomly divided into training (n = 74) and validation (n = 32) cohorts at a 7:3 ratio. We segmented tumor regions on pre-and post-treatment CT scans using ITK-SNAP, then extracted radiomic features and applied mRMR-LASSO (Minimum Redundancy Maximum Relevance-Least Absolute Shrinkage and Selection Operator). A delta-radiomics model was developed by quantifying feature changes between treatment phases. Significant clinical predictors identified by logistic regression were integrated with radiomic features to build a combined model. Performance was assessed via AUC, sensitivity, specificity, accuracy, positive predictive value (PPV), negative predictive value (NPV), DeLong's test, calibration curves, and decision curve analysis. RESULTS: In the pre-treatment radiomics model, the AUC, accuracy, sensitivity, specificity, PPV, and NPV of the training cohorts were 0.751, 0.690, 0.737, 0.639, 0.683, and 0.697; in validation cohorts, these values were 0.726, 0.656, 0.778, 0.500, 0.667, and 0.636. In the delta-radiomics model, the AUC, accuracy, sensitivity, specificity, PPV, and NPV of the training cohorts were 0.906, 0.865, 0.868, 0.861, 0.868, and 0.861, vs. 0.825, 0.719, 0.722, 0.714, 0.765, and 0.667 in validation. For the clinical model, the AUC, accuracy, sensitivity, specificity, PPV, and NPV of the training cohorts were 0.828, 0.729, 0.737, 0.722, 0.737, and 0.722, compared to 0.766, 0.750, 0.722, 0.786, 0.812, and 0.688 in validation. In the combined model, the AUC, accuracy, sensitivity, specificity, PPV, and NPV of the training cohorts were 0.977, 0.946, 0.947, 0.944, 0.947, and 0.944, while in the validation cohorts, these values were 0.913, 0.781, 0.778, 0.786, 0.824, and 0.733. CONCLUSION: The combined model integrating delta-radiomics with clinical predictors demonstrates superior predictive performance for evaluating targeted therapy efficacy in EGFR-mutated advanced lung adenocarcinoma, significantly outperforming conventional radiomics models relying exclusively on pre-treatment imaging data.