{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T05:00:30Z","timestamp":1785387630809,"version":"3.55.0"},"reference-count":24,"publisher":"Wiley","issue":"14","license":[{"start":{"date-parts":[[2026,7,26]],"date-time":"2026-07-26T00:00:00Z","timestamp":1785024000000},"content-version":"vor","delay-in-days":25,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Thoracic Cancer"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The prognostic value of CT\u2010detected tumor necrosis in advanced non\u2010small cell lung cancer (NSCLC) treated with immune checkpoint inhibitor (ICI) monotherapy remains unclear. This two\u2010center retrospective study investigated whether tumor necrosis on pretreatment CT independently predicts overall survival (OS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A total of 151 advanced NSCLC patients who received ICI monotherapy between March 2016 and August 2021 at two Japanese institutions were retrospectively analyzed. Tumor necrosis was visually assessed and operationally defined as an intratumoral area of low attenuation or cavitary lesion \u2265\u20095\u2009mm on pretreatment chest CT (contrast\u2010enhanced in 113 patients [75%] and non\u2010contrast in 38 [25%]). Cox regression analyses identified independent prognostic factors for OS, with internal validation using 1000 bootstrap resamples.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 151 patients (mean age 69\u2009years; 90% with ECOG PS 0\u20131), 121 (80%) had CT\u2010detected necrosis. Median OS was significantly shorter in necrosis\u2010positive patients than in necrosis\u2010negative patients (374 vs. 1035\u2009days; log\u2010rank\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.02). A multivariate Cox regression analysis identified tumor necrosis as an independent adverse prognostic factor (HR\u2009=\u20091.84, 95% CI\u2009=\u20091.03\u20133.30;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.04), along with blood\u2010based biomarkers, tumor size, and PD\u2010L1 expression. The detection rate of necrosis differed between CT modalities (contrast\u2010enhanced 84% vs. non\u2010contrast 68%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.04).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This exploratory two\u2010center retrospective study indicates the potential of CT\u2010detected tumor necrosis as a readily accessible prognostic marker in ICI\u2010treated NSCLC. However, the results obtained require validation in larger, prospective, multicenter studies with standardized CT imaging protocols before clinical implementation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/1759-7714.70363","type":"journal-article","created":{"date-parts":[[2026,7,26]],"date-time":"2026-07-26T12:03:21Z","timestamp":1785067401000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Tumor Necrosis on Routine Pretreatment\n                    <scp>CT<\/scp>\n                    as a Potential Prognostic Marker in Advanced\n                    <scp>NSCLC<\/scp>\n                    Treated With Immune Checkpoint Inhibitor Monotherapy: A Two\u2010Center Retrospective Study"],"prefix":"10.1111","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1541-9747","authenticated-orcid":false,"given":"Eiji","family":"Takeuchi","sequence":"first","affiliation":[{"name":"Department of 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