Spatial imaging features derived from SUVmax location in resectable NSCLC are associated with tumor aggressiveness

Title (eng)
Spatial imaging features derived from SUVmax location in resectable NSCLC are associated with tumor aggressiveness
Author
Zewen Jiang
Author
Clemens Spielvogel
Author
David Haberl
Author
Josef Yu
Author
Maximilian Krisch
Author
Szabolcs Szakall
Author
Peter Molnar
Author
Janos Fillinger
Author
Lilla Horvath
Author
Ferenc Renyi-Vamos
Author
Clemens Aigner
Author
Balazs Dome
Author
Christian Lang
Author
Zsolt Megyesfalvi
Author
Lukas Kenner
Author
Marcus Hacker
Abstract (eng)
Purpose Accurate non-invasive prediction of histopathologic invasiveness and recurrence risk remains a clinical challenge in resectable non-small cell lung cancer (NSCLC). We developed and validated the Edge Proximity Score (EPS), a novel [18F]FDG PET/CT-based spatial imaging feature that quantifies the displacement of SUVmax relative to the tumor centroid and perimeter, to assess tumor aggressiveness and predict progression-free survival (PFS). Methods This retrospective study included 244 NSCLC patients with preoperative [18F]FDG PET/CT. EPS was computed from normalized SUVmax-to-centroid and SUVmax-to-perimeter distances. A total of 115 PET radiomics features were extracted and standardized. Eight machine learning models (80:20 split) were trained to predict lymphovascular invasion (LVI), visceral pleural invasion (VPI), and spread through air spaces (STAS), with feature importance assessed using SHAP. Prognostic analysis was conducted using multivariable Cox regression. A survival prediction model incorporating EPS was externally validated in the TCIA cohort. RNA sequencing data from 76 TCIA patients were used for transcriptomic and immune profiling. Results EPS was significantly elevated in tumors with LVI, VPI, and STAS (P < 0.001), consistently ranked among the top SHAP features, and was an independent predictor of PFS (HR = 2.667, P = 0.015). The EPS-based nomogram achieved AUCs of 0.67, 0.70, and 0.68 for predicting 1-, 3-, and 5-year PFS in the TCIA validation cohort. High EPS was associated with proliferative and metabolic gene signatures, whereas low EPS was linked to immune activation and neutrophil infiltration. Conclusion EPS is a biologically relevant, non-invasive imaging biomarker that may improve risk stratification in NSCLC.
Keywords (eng)
NSCLCTumor Invasiveness[18F]FDG PET/CTRadiomics
Type (eng)
journal article
Language
[eng]
Persistent identifier
https://phaidra.vetmeduni.ac.at/o:5344
DOI
10.1007/s00259-025-07528-0
Is in series
Title (eng)
European Journal of Nuclear Medicine and Molecular Imaging
Volume
53
Issue
3
ISSN
1619-7070
Issued
2026
Number of pages
11
Publication
Springer
Version type (eng)
version of record (published version)
Date issued
2026
Access rights (eng)
open access
License
CC BY 4.0 International
Rights statement (eng)
© 2025, The Author(s)