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However, relevant research in non-small cell lung cancer (NSCLC) remains limited. This study aimed to determine the prognostic value of tumor fibrosis and develop a novel radiomics fibrosis stratification tool (RaFiST) for non-invasive patient stratification.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>In this multicenter retrospective study of 532 patients with resected NSCLC, tumor fibrosis was histopathologically quantified via collagen fraction. RaFiST was developed using pre-treatment contrast-enhanced CT scans from training and external test cohorts. Prognostic performance was subsequently compared among clinical, direct radiomics, and combined models. Transcriptomic analysis investigated the model\u2019s underlying molecular mechanisms.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Multivariable Cox regression revealed that the fibrosis score was an independent risk factor for disease-free survival (DFS) and overall survival (OS) at both centers. An optimal cutoff of 11.12% stratified patients into high- and low-fibrosis groups. RaFiST demonstrated excellent performance in predicting tumor fibrosis, achieving an area under the curve (AUC) of 0.879 in the training cohort and 0.813 in the test cohort. RaFiST-High patients exhibited significantly worse survival across both cohorts (all\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.01). Furthermore, the combined Clinical-RaFiST model outperformed the baseline clinical and direct radiomics models, yielding a 5-year DFS AUC of 0.827. Transcriptomic analysis associated the RaFiST-High group with pathways for extracellular matrix remodeling, hypoxia, and immune suppression.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Tumor fibrosis is an independent prognostic risk factor in NSCLC. RaFiST provides a robust, non-invasive imaging biomarker for tumor fibrosis stratification and prognostic prediction.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Key Points<\/jats:title>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Question<\/jats:italic>\n                      <\/jats:bold>\n                      <jats:italic>Tumor fibrosis plays a critical role in tumor therapeutic heterogeneity and drug resistance. However, relevant research in non-small cell lung cancer (NSCLC) remains relatively limited<\/jats:italic>\n                      .\n                    <\/jats:p>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Findings<\/jats:italic>\n                      <\/jats:bold>\n                      <jats:italic>Tumor fibrosis is an independent prognostic factor in NSCLC, and radiomics fibrosis stratification tool (RaFiST), a CT-based radiomics model provides a robust non-invasive biomarker for fibrosis stratification and outcome prediction<\/jats:italic>\n                      .\n                    <\/jats:p>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Clinical relevance<\/jats:italic>\n                      <\/jats:bold>\n                      <jats:italic>RaFiST offers a non-invasive, reproducible framework to evaluate tumor fibrosis in NSCLC, thereby enabling the earlier identification of postoperative patients with poor prognoses for prompt adjuvant therapy<\/jats:italic>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00330-026-12764-5","type":"journal-article","created":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T04:22:26Z","timestamp":1787199746000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["RaFiST: a radiomics model for non-invasive stratification of tumor fibrosis and prognostic prediction in non-small cell lung cancer"],"prefix":"10.1007","author":[{"given":"Yu","family":"Zong","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liying","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinyu","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoqing","family":"Cheng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianrui","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhiyuan","family":"Sun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hao","family":"Tang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Changsheng","family":"Zhou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yang","family":"Cao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haijun","family":"Luo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ying","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Longjiang","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4913-2314","authenticated-orcid":false,"given":"Guangming","family":"Lu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,8,20]]},"reference":[{"key":"12764_CR1","doi-asserted-by":"publisher","DOI":"10.1186\/s13073-022-01127-6","volume":"14","author":"AL Parker","year":"2022","unstructured":"Parker AL, Bowman E, Zingone A et al (2022) Extracellular matrix profiles determine risk and prognosis of the squamous cell carcinoma subtype of non-small cell lung carcinoma. 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