Tumor Necrosis on Routine Pretreatment CT as a Potential Prognostic Marker in Advanced NSCLC Treated With Immune...

Area of Science:

• Oncology
• Radiology
• Medical Imaging

Background:

• Prognostic value of CT-detected tumor necrosis in advanced non-small cell lung cancer (NSCLC) treated with immune checkpoint inhibitors (ICIs) is unclear.
• This study investigates tumor necrosis on pretreatment CT as an independent predictor of overall survival (OS).

Purpose of the Study:

• To determine if CT-detected tumor necrosis independently predicts overall survival (OS) in advanced NSCLC patients receiving ICI monotherapy.
• To evaluate the prognostic significance of tumor necrosis in this patient population.

Main Methods:

• Retrospective analysis of 151 advanced NSCLC patients treated with ICI monotherapy at two Japanese institutions.
• Tumor necrosis defined as intratumoral low attenuation or cavitary lesion ≥5mm on pretreatment CT; assessed visually.
• Cox regression analyses used to identify independent prognostic factors for OS, with bootstrap validation.

Main Results:

• 121 out of 151 patients (80%) showed CT-detected necrosis.
• Median OS was significantly shorter in patients with necrosis (374 days) compared to those without (1035 days; p=0.02).
• Tumor necrosis was an independent adverse prognostic factor (HR=1.84, p=0.04), alongside other biomarkers and clinical factors.

Conclusions:

• CT-detected tumor necrosis shows potential as an accessible prognostic marker for NSCLC patients treated with ICIs.
• Further validation in larger, prospective, multicenter studies with standardized CT protocols is necessary before clinical application.