{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,20]],"date-time":"2026-02-20T23:32:50Z","timestamp":1771630370494,"version":"3.50.1"},"reference-count":62,"publisher":"Public Library of Science (PLoS)","issue":"12","license":[{"start":{"date-parts":[[2020,12,28]],"date-time":"2020-12-28T00:00:00Z","timestamp":1609113600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>To investigate the survival prognostic value of the radiomic features of <jats:sup>18<\/jats:sup>F-FDG PET in patients who had EGFR (epidermal growth factor receptor) mutated lung adenocarcinoma and received targeted TKI (tyrosine kinase inhibitor) treatment.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>Fifty-one patients with stage III-IV lung adenocarcinoma and actionable EGFR mutation who received first-line TKI were retrospectively analyzed. All patients underwent pretreatment <jats:sup>18<\/jats:sup>F-FDG PET\/CT, and we calculated the PET-derived radiomic features. Cox proportional hazard model was used to examine the association between the radiomic features and the survival outcomes, including progression-free survival (PFS) and overall survival (OS). A score model was established according to the independent prognostic predictors and we compared this model to the TNM staging system using Harrell's concordance index (c-index).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Forty-eight patients (94.1%) experienced disease progression and 41 patients (80.4%) died. Primary tumor SUV entropy &gt; 5.36, and presence of pleural effusion were independently associated with worse OS (both <jats:italic>p<\/jats:italic> &lt; 0.001) and PFS (<jats:italic>p<\/jats:italic> = 0.001, and 0.003, respectively). We used these two survival predictors to devise a scoring system (score 0\u20132). Patients with a score of 1 or 2 had a worse survival than those with a score of 0 (HR for OS: 3.6, <jats:italic>p<\/jats:italic> = 0.006 for score 1, and HR: 21.8, <jats:italic>p<\/jats:italic> &lt; 0.001 for score 2; HR for PFS: 2.2, <jats:italic>p<\/jats:italic> = 0.027 for score 1 and HR: 8.8, <jats:italic>p<\/jats:italic> &lt; 0.001 for score 2). Our scoring system surpassed the TNM staging system (c-index = 0.691 versus 0.574, <jats:italic>p<\/jats:italic> = 0.013 for OS, and c-index = 0.649 versus 0.517, <jats:italic>p<\/jats:italic> = 0.004 for PFS).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>In this preliminary study, combining PET radiomics with clinical risk factors may improve survival stratification in stage III-IV lung adenocarcinoma with actionable EFGR mutation. Our proposed scoring system may assist with optimization of individualized treatment strategies in these patients.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0244502","type":"journal-article","created":{"date-parts":[[2020,12,28]],"date-time":"2020-12-28T18:58:10Z","timestamp":1609181890000},"page":"e0244502","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":20,"title":["Incorporating radiomic feature of pretreatment 18F-FDG PET improves survival stratification in patients with EGFR-mutated lung 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