Progress in Serial Imaging for Prognostic Stratification of Lung Cancer Patients Receiving Immunotherapy: A Systematic Review and Meta-Analysis

Abstract

Immunotherapy, particularly with checkpoint inhibitors, has revolutionized non-small cell lung cancer treatment. Enhancing the selection of potential responders is crucial, and researchers are exploring predictive biomarkers. Delta radiomics, a derivative of radiomics, holds promise in this regard. For this study, a meta-analysis was conducted that adhered to PRISMA guidelines, searching PubMed, Embase, Web of Science, and the Cochrane Library for studies on the use of delta radiomics in stratifying lung cancer patients receiving immunotherapy. Out of 223 initially collected studies, 10 were included for qualitative synthesis. Stratifying patients using radiomic models, the pooled analysis reveals a predictive power with an area under the curve of 0.81 (95% CI 0.76-0.86, p < 0.001) for 6-month response, a pooled hazard ratio of 4.77 (95% CI 2.70-8.43, p < 0.001) for progression-free survival, and 2.15 (95% CI 1.73-2.66, p < 0.001) for overall survival at 6 months. Radiomics emerges as a potential prognostic predictor for lung cancer, but further research is needed to compare traditional radiomics and deep-learning radiomics.

Keywords: computed tomography; immune checkpoint inhibitor; immunotherapy; non-small cell lung cancer; radiomics; treatment outcome.

Figure 1

PRISMA flowchart of the included studies.

Figure 2

Quality assessment. (a) Risk of bias for individual studies. (b) Summary of risk of biases [32,33,34,35,36,37,38,39,40,41].

Figure 3

Forest plots of the predictive performance of radiomics models in progression-free survival and overall survival of NSCLC patients treated with immunotherapy [32,33,34,35,36,37,38,39,41]. (a) The 6-month response, (b) hazard ratio for progression-free survival, (c) hazard ratio for overall survival.

Figure 4

Funnel plots of the pooled predictive performance of radiomics models in progression-free survival and overall survival of NSCLC patients treated with immunotherapy. (a) The 6-month response AUC, (b) hazard ratio for progression-free survival, (c) hazard ratio for overall survival.