Prognostic factors for overall survival of stage III non-small cell lung cancer patients on computed tomography: A systematic review and meta-analysis

Abstract

Introduction: Prognosis prediction is central in treatment decision making and quality of life for nonsmall cell lung cancer (NSCLC) patients. However, conventional computed tomography (CT) related prognostic factors may not apply to the challenging stage III NSCLC group. The aim of this systematic review was therefore to identify and evaluate CT-related prognostic factors for overall survival (OS) of stage III NSCLC. Methods: The Medline, Embase, and Cochrane electronic databases were searched. After study selection, risk of bias was estimated for the included studies. Meta-analysis of univariate results was performed when sufficient data were available. Results: 1595 of the 11,996 retrieved records were selected for full text review, leading to inclusion of 65 studies that reported data of 144,513 stage III NSCLC patients andcompromising 26 unique CT-related prognostic factors. Relevance and validity varied substantially, few studies had low relevance and validity. Only four studies evaluated the added value of new prognostic factors compared with recognized clinical factors. Included studies suggested gross tumor volume (meta-analysis: HR = 1.22, 95%CI: 1.05-1.42), tumor diameter, nodal volume, and pleural effusion, are prognostic in patients treated with chemoradiation. Clinical T-stage and location (right/left) were likely not prognostic within stage III NSCLC. Inconclusive are several radiomic features, tumor volume, atelectasis, location (pulmonary lobes, central/peripheral), interstitial lung abnormalities, great vessel invasion, pit-fall sign, and cavitation. Conclusions: Tumor-size and nodal size-related factors are prognostic for OS in stage III NSCLC. Future studies should carefully report study characteristics and contrast factors with guideline recognized factors to improve evidence evaluation and validation.

First-Line Pembrolizumab Mono- or Combination Therapy of Non-Small Cell Lung Cancer: Baseline Metabolic Biomarkers Predict Outcomes

“…From a clinical point of view, it is not surprising that metabolically active tumor burden as measured by MTV turned out as the most relevant tumor-related quantitative PET/CT biomarker in our cohort. Similar observations have been reported for various disease stages of NSCLC, using PET/CT or conventional CT imaging for both the determination of baseline tumor burden and response to ICI [ 21 , 23 , 30 , 53 , 54 ]. Concerning first-line treatment using mono-ICI therapy, Dall’Olio et al recently reported an MTV ≥ 75 cm 3 as a biomarker of poor prognosis in a cohort of 34 pembrolizumab-treated NSCLC patients with PD-L1 expression ≥50%, with an OS of 4.7 M (0.3–9.1), while median OS was not reached in patients with MTV < 75 m 3 [ 22 ].…”

Radiomics as a New Frontier of Imaging for Cancer Prognosis: A Narrative Review

“…Finally, it is of great interest to report two meta-analyses recently published in the field of prognosis and lung cancer. The analysis by van Laar et al [57] concluded that the only factors affecting survival in stage III lung cancer are tumor-size and nodal-size related factors. Kothari et al [58], again, analyzed the prognostic value of the radiomics model in lung cancer and found significant heterogeneity among the studies (I 2 = 70.3%).…”

“…Specifically, Van Laar [57] selected 11,996 results (including 519 duplicates) for his meta-analysis and after cross-reference searching, included a total of 65 publications, with 26 individual CT-related prognostic factors for OS of patients with stage III NSCLC described. The results show that tumor diameter is prognostic for patients with stage IIIB NSCLC.…”

Prognostic Factors of IIIAN2 Non-Small-Cell Lung Cancer after Complete Resection: A Systemic Review and Meta-analysis

“…Cancer is one of the leading causes of all medical mortalities and one of the greatest medical challenges to date [ 1 , 2 ]. Human lungs are the most reported target sites for cancer development with a comparatively poor survival rate [ 1 ].…”