Subvisual imaging signals as biomarkers of impending lung metastasis: A multicenter pan-cancer study
Ranze Zhang1, Haojiang Li2, Lei Ding3
1Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Guangdong-Hong Kong Joint Laboratory for RNA Medicine, Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou 510120, China; Guangdong Provincial Clinical Research Center for Breast Diseases, Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China.
Study Aim:
Early detection of distant metastases is crucial, but current imaging detects them only when radiographically visible. This study reported subvisual chest CT signals could serve as early biomarkers for impending lung metastasis before radiological visibility.
Methods:
This multicenter study enrolled breast, colorectal, and esophageal cancer patients from four hospitals, with at least three follow-up chest CT scans per patient. Signaling features were extracted from 3D lung regions of interest (ROIs). Using Multi-TimePoint Modeling approach, we analyzed features across time points to develop machine learning models, with performance evaluated by the area under the curve. A predefined cutoff classified patients as Signal-Positive or Signal-Negative, and the actual lung metastasis risk was compared between these groups. The lead time that spanned from first Signal-Positivity to metastasis, and the impact of CT scan count and interval on model performance were explored.
Results:
This study analyzed 10,280 follow-up chest CT scans from 2148 cancer patients. Signal-Positive patients showed significantly higher actual lung metastasis risk than Signal-Negative patients: 57.14 % vs 5.77 % (breast, adjusted p < 0.0001), 66.67 % vs 6.25 % (colorectal, adjusted p = 0.0361), and 50.00 % vs 12.50 % (esophageal, adjusted p = 0.0480). The lead times were 0.84 years (breast), 1.41 years (colorectal), and 0.83 years (esophageal). At least two CT scans within 1.5 years (breast/colorectal cancer) or 0.5 years (esophageal cancer) are recommended for model application.
Conclusion:
Subvisual chest CT signals serve as biomarkers for impending lung metastasis detection across cancers. This non-invasive approach dynamically identifies high-risk patients, enabling possible early intervention.
