Abstract
Background: Lung cancer remains the leading cause of cancer-related mortality worldwide, with non-small cell lung cancer (NSCLC) accounting for the majority of cases. Radiomics and artificial intelligence (AI) have emerged as promising tools for quantitative imaging analysis and precision staging. This study aimed to evaluate the ability of an AI-based radiomics model to preoperatively predict tumor (T) and nodal (N) stage, lymphovascular invasion (LVI), and postoperative complications in patients with early-stage NSCLC. Material and Methods: This retrospective study included 51 consecutive patients who underwent anatomical lobectomy with systematic lymph node dissection between 2019 and 2024, at the Clinic for Thoracic Surgery of the University Clinical Center of Serbia. Quantitative imaging features were extracted from preoperative CT scans using the Lesion Scout with Auto ID module (syngo.via VB50 MM, Siemens Healthineers). Radiomics and clinical predictors were analyzed using regularized logistic regression (LASSO) with five-fold cross-validation. Model performance was assessed using AUC, accuracy, sensitivity, specificity, precision, and F1 score, and calibration was evaluated using the Hosmer-Lemeshow test. Groups were compared using parametric and non-parametric tests. Correlation between the variables was assessed using Spearman's rank correlation coefficient. All p-values less than 0.05 were considered significant. Results: The AI-based model showed excellent performance for predicting the T component (training AUC = 0.89; test AUC = 0.86; F1 = 0.81) and acceptable calibration (p = 0.41). Nodal metastasis (OR = 0.108; 95% CI: 0.011-1.069; p = 0.057) and LVI (OR = 0.519; 95% CI: 0.139-1.937; p = 0.329) were not significantly predicted. Emphysema was identified as a significant independent predictor of postoperative complications (χ(2) = 5.13; p = 0.024). Conclusions: The AI-driven radiomics model demonstrated strong predictive ability for the T component and identified emphysema as a clinically relevant predictor of postoperative complications.