Abstract
Purpose: This study aims to develop a predictive model for epidermal growth factor receptor (EGFR) mutations in lung adenocarcinoma by integrating computed tomography (CT) imaging features with clinical characteristics. Methods: A retrospective analysis was conducted using electronic medical records from 194 patients diagnosed with lung adenocarcinoma between January 2016 and December 2020, with approval from the institutional review board. Features were selected using LASSO regression, and predictive models were built using logistic regression, support vector machine, and random forest methods. Individual models were created for clinical features, CT imaging features, and a combined model to predict EGFR mutations. Results: The training set revealed that alcohol consumption, intrapulmonary metastasis, and pleural effusion were statistically significant in distinguishing between wild-type and mutation groups (p < 0.05). In the testing set, hilar and mediastinal lymphadenopathy showed statistical significance (p < 0.05). The combined model outperformed the individual clinical and CT imaging feature models. In the testing set, the logistic regression model achieved the highest AUC of 0.827, with sensitivity, specificity, and accuracy of 0.714, 0.712, and 0.712, respectively. Nomogram analysis identified lobulation as an important feature, with a predicted probability of up to 0.9. The decision curve analysis showed that the CT imaging feature model provided a higher net benefit compared to both the clinical feature model and the combined model. Conclusion: In summary, while the combined model outperformed the individual feature models in the testing set, the CT imaging feature model demonstrated the greatest clinical net benefit. Lobulation was identified as an important predictor of EGFR mutations in lung adenocarcinoma.