CT heterogeneity score predicts lymphovascular invasion and survival in lung adenocarcinoma

CT-based intratumoral heterogeneity score predicted lymphovascular invasion with AUC 0.886 (internal) and 0.850 (external) in lung adenocarcinoma. High score linked to worse recurrence-free survival (HR 12.92, 95% CI 3.90–42.78) and overall survival (HR 26.47, 95% CI 3.52–198.76…

• In a multicenter study of 1322 patients, a random forest classifier using CT-derived intratumoral heterogeneity features achieved AUCs of 0.886 (95% CI 0.842-0.923) in internal validation and 0.850 (95% CI 0.806-0.892) in external validation for preoperative lymphovascular invasion prediction.
• High intratumoral heterogeneity score was independently associated with worse recurrence-free survival (HR 12.92, 95% CI 3.90-42.78, P<0.001) and overall survival (HR 26.47, 95% CI 3.52-198.76, P=0.001).
• Exploratory radiogenomic analysis in a subset of 117 patients showed enrichment of hypoxia, angiogenesis, epithelial-mesenchymal transition, and glycolysis pathways, suggesting biological correlates.

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