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Prognostic and Diagnostic Value of Node-RADS for Non-Small Cell Lung Cancer Following Neoadjuvant Therapy: A
Jianyu Wang1,2, Yuhang Wang3, Hao Chen4
1Graduate School, Tianjin Medical University, Tianjin 300070, China.
None:
Background/Objectives: The aim of this study was to evaluate the performance of the Node-RADS scoring system for predicting lymph node metastasis in patients with non-small cell lung cancer (NSCLC) after neoadjuvant therapy and to assess its prognostic value for overall survival (OS) and event-free survival (EFS). Methods: A total of 247 patients with non-small cell lung cancer (NSCLC) from three centers who underwent surgery after neoadjuvant therapy were retrospectively enrolled. Post-treatment Node-RADS scores were reassessed by radiologists based on preoperative contrast-enhanced CT images. Logistic regression analysis was used to evaluate the predictive value of Node-RADS for postoperative pathological lymph node metastasis, while Cox regression analysis was performed to assess its associations with OS and EFS. Kaplan-Meier analysis was used to compare survival differences among different Node-RADS risk groups. Results: A total of 247 patients were included in this study, comprising 211 men and 36 women, with a mean age of 63.40 ± 7.58 years. Post-treatment Node-RADS score was significantly associated with both OS and EFS. In multivariable Cox regression analysis, Node-RADS remained independently associated with OS (HR = 1.79, 95% CI: 1.50-2.15, p < 0.001) and EFS (HR = 1.41, 95% CI: 1.23-1.62, p < 0.001). Using a Node-RADS score of 3 as the cutoff value, patients in the high-risk group had significantly worse OS and EFS than those in the low-risk group (both p < 0.01). For the prediction of lymph node metastasis, the inclusion of post-treatment Node-RADS markedly improved the discriminatory performance of the model, with an AUC of 0.769, a sensitivity of 46.2%, and a specificity of 87.6%. Conclusions: The Node-RADS score may provide useful imaging information for patient-level assessment of residual lymph node metastasis risk and survival stratification in patients with NSCLC after neoadjuvant therapy. These findings suggest that the scoring system may support patient-level post-treatment risk assessment.