Machine learning-based radiomics for guiding lymph node dissection in clinical stage I lung adenocarcinoma: a multicenter retrospective study.

Background: Preoperative assessment of lymph node status is critical in managing lung cancer, as it directly impacts the surgical approach and treatment planning. However, in clinical stage I lung adenocarcinoma (LUAD), determining lymph node metastasis (LNM) is often challenging due to the limited sensitivity of conventional imaging modalities, such as computed tomography (CT) and positron emission tomography/CT (PET/CT). This study aimed to establish an effective radiomics prediction model using multicenter data for early assessment of LNM risk in patients with clinical stage I LUAD. The goal is to provide a basis for formulating lymph node dissection strategies before surgery in early-stage lung cancer patients. Methods: A total of 578 patients with LUAD from three medical centers [Cancer Hospital, Chinese Academy of Medical Sciences (CCAM), the First Affiliated Hospital of Chongqing Medical University (1CMU), and Beijing Chao-Yang Hospital (BCYH)] who underwent preoperative chest CT were divided into three groups, the training group (n=336), the testing group (n=167), and the independent validation group (n=75). The records of 1,316 radiomics features of each primary tumor were extracted. The least absolute shrinkage and selection operator (LASSO) analysis and multivariable logistic regression were used to reduce the data dimensionality, select features, and construct the prediction models. Results: In the training group, the area under the curve (AUC) for the clinical model, radiomics model, and composite model were 0.820, 0.871, and 0.883, respectively. In the testing group, the AUC for the clinical model, radiomics model, and composite model were 0.897, 0.915, and 0.934, respectively. In the validation set, the AUC of the radiomics model was the highest at 0.870, while the composite model and clinical model had AUCs of 0.841 and 0.710, respectively. The results of the Delong test showed that the AUCs of the radiomics model and composite model were significantly higher than those of the clinical model in both the training and validation groups. The decision curve analysis showed that the radiomics nomogram was clinically useful. Conclusions: This study developed and validated a radiomics prediction model, which enables easy LNM prediction in stage I LUAD patients. This model provides a basis for formulating lymph node dissection strategies before surgery and helps to better determine the tumor node metastasis stage of the early-stage LUAD.