{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,19]],"date-time":"2025-12-19T05:29:05Z","timestamp":1766122145087,"version":"3.48.0"},"reference-count":55,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,12,19]],"date-time":"2025-12-19T00:00:00Z","timestamp":1766102400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:sec>\n                    <jats:title>Background and objective<\/jats:title>\n                    <jats:p>Selecting the optimal treatment for locally advanced non-small cell lung cancer (LA-NSCLC) is complex and typically requires multidisciplinary tumor board (MTB) evaluation. This study investigated whether machine learning (ML) models trained on MTB decisions could support treatment selection by integrating clinicopathological characteristics with radiomic features from both the primary tumor and mediastinal lymph nodes (LN).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>We retrospectively analyzed patients with LA-NSCLC whose treatments had been decided by an expert MTB. Patients were categorized into three pathways: (A) upfront surgery, (B) neoadjuvant systemic treatment followed by surgery, (C) concurrent chemoradiotherapy. Baseline CT scans were segmented to extract radiomic features from primary tumors and mediastinal LNs. Two ML models were developed based on clinicopathological and radiomic data, using MTB decisions as ground truth: (1) A vs. Rest and (2) B vs. C. Performance was assessed in independent training and test cohorts using the area under the receiver operating characteristic curve (AUC) and accuracy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In the training cohort, the A vs. Rest achieved an AUC of 0.847 and accuracy of 0.795 with 13 features, while the B vs. C model reached an AUC of 0.740 and accuracy of 0.700 with 9 features. In the test cohort, results remained robust, with an AUC of 0.808 (accuracy 0.700) for A vs. Rest and an AUC of 0.754 (accuracy 0.740) for B vs. C.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>ML models combining clinicopathological and radiomic features can reproduce MTB treatment recommendations for LA-NSCLC with good accuracy. This approach may provide decision in settings with limited MTB expertise and promote more consistent treatment allocation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fonc.2025.1713847","type":"journal-article","created":{"date-parts":[[2025,12,19]],"date-time":"2025-12-19T05:16:58Z","timestamp":1766121418000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Radiomic approach to support multidisciplinary tumor board decision-making in locally advanced non-small cell lung cancer"],"prefix":"10.3389","volume":"15","author":[{"given":"Giulia","family":"Pasello","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Harel","family":"Kotler","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alessandra","family":"Ferro","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luca","family":"Bergamin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elena","family":"Scagliori","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Angela","family":"Grassi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fabio","family":"Aiolli","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mattia","family":"De Nuzzo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marco","family":"Schiavon","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matteo","family":"Sepulcri","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marco","family":"Krengli","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Valentina","family":"Guarneri","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesca","family":"Caumo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gisella","family":"Gennaro","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,12,19]]},"reference":[{"key":"B1","unstructured":"Lung cancer\n          \n          2023"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1158\/1078-0432.CCR-17-3620","article-title":"The integration of radiotherapy with immunotherapy for the treatment of non-small cell lung cancer","volume":"24","author":"Ko","year":"2018","journal-title":"Clin Cancer Res"},{"key":"B3","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1016\/J.JTHO.2015.09.009","article-title":"The IASLC lung cancer staging project: proposals for revision of the TNM stage groupings in the forthcoming (Eighth) edition of the TNM classification for lung cancer","volume":"11","author":"Goldstraw","year":"2016","journal-title":"J Thorac Oncol"},{"key":"B4","doi-asserted-by":"publisher","first-page":"193","DOI":"10.1016\/j.chest.2016.10.010","article-title":"The eighth edition lung cancer stage classification","volume":"151","author":"Detterbeck","year":"2017","journal-title":"Chest"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.4329\/WJR.V9.I6.269","article-title":"Revisions to the Tumor, Node, Metastasis staging of lung cancer (8th edition): Rationale, radiologic findings and clinical implications","volume":"9","author":"Kay","year":"2017","journal-title":"World J Radiol"},{"key":"B6","doi-asserted-by":"publisher","first-page":"240047","DOI":"10.1183\/20734735.0047-2024","article-title":"Stage III NSCLC treatment options: too many choices","volume":"20","author":"Asmara","year":"2024","journal-title":"Breathe"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1016\/J.JAMCOLLSURG.2013.04.035","article-title":"Improving decision making in multidisciplinary tumor boards: prospective longitudinal evaluation of a multicomponent intervention for 1,421 patients","volume":"217","author":"Lamb","year":"2013","journal-title":"J Am Coll Surg"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1016\/J.THORSURG.2021.07.008","article-title":"Assessment of operability and resectability in lung cancer","volume":"31","author":"Shamji","year":"2021","journal-title":"Thorac Surg Clin"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMOA2202170\/SUPPL_FILE\/NEJMOA2202170_DATA-SHARING.PDF","article-title":"Neoadjuvant nivolumab plus chemotherapy in resectable lung cancer","volume":"386","author":"Forde","year":"2022","journal-title":"New Engl J Med"},{"key":"B10","volume-title":"IMpower010: Final disease-free survival (DFS) and second overall survival (OS) interim results after \u22655 years of follow up of a phase III study of adjuvant atezolizumab vs best supportive care in resected stage IB-IIIA non-small cell lung cancer (NSCLC). J Clin Oncol","author":"Wakelee","year":"2010"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2311926","article-title":"Perioperative nivolumab in resectable lung cancer","volume":"390","author":"Cascone","year":"2024","journal-title":"N Engl J Med"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(20)30453-8","article-title":"Neoadjuvant chemotherapy and nivolumab in resectable non-small-cell lung cancer (NADIM): an open-label, multicentre, single-arm, phase 2 trial","volume":"21","author":"Provencio","year":"2020","journal-title":"Lancet Oncol"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMOA2215530","article-title":"Perioperative nivolumab and chemotherapy in stage III non-small-cell lung cancer","volume":"389","author":"Provencio","year":"2023","journal-title":"N Engl J Med"},{"key":"B14","doi-asserted-by":"publisher","first-page":"3 2023","DOI":"10.1038\/s41591-022-02189-0","article-title":"Neoadjuvant chemotherapy plus nivolumab with or without ipilimumab in operable non-small cell lung cancer: the phase 2 platform NEOSTAR trial","volume":"29","author":"Cascone","year":"2023","journal-title":"Nat Med"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1001\/JAMA.2023.24735","article-title":"Perioperative toripalimab plus chemotherapy for patients with resectable non-small cell lung cancer: the neotorch randomized clinical trial","volume":"331","author":"Lu","year":"2024","journal-title":"JAMA"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.21.00276","article-title":"SAKK 16\/14: durvalumab in addition to neoadjuvant chemotherapy in patients with stage IIIA(N2) non-small-cell lung cancer-A multicenter single-arm phase II trial","volume":"39","author":"Rothschild","year":"2021","journal-title":"J Clin Oncol"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1016\/j.annonc.2022.02.224","article-title":"VP3-2022: Pembrolizumab (pembro) versus placebo for early-stage non-small cell lung cancer (NSCLC) following complete resection and adjuvant chemotherapy (chemo) when indicated: Randomized, triple-blind, phase III EORTC-1416-LCG\/ETOP 8-15 \u2013 PEARLS\/KEYNOTE-091 study","volume":"33","author":"Paz-Ares","year":"2022","journal-title":"Ann Oncol"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.2217\/FON-2021-0549","article-title":"Neoadjuvant osimertinib with\/without chemotherapy versus chemotherapy alone for EGFR-mutated resectable non-small-cell lung cancer: NeoADAURA","volume":"17","author":"Tsuboi","year":"2021","journal-title":"Future Oncol"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMOA2304594","article-title":"Overall survival with osimertinib in resected EGFR-mutated NSCLC","volume":"389","author":"Tsuboi","year":"2023","journal-title":"N Engl J Med"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1016\/J.ANNONC.2023.10.051","article-title":"LBA2 ALINA: Efficacy and safety of adjuvant alectinib versus chemotherapy in patients with early-stage ALK+ non-small cell lung cancer (NSCLC)","volume":"34","author":"Solomon","year":"2023","journal-title":"Ann Oncol"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1016\/J.CLLC.2021.02.014","article-title":"Open-label, single-arm, multicenter study to assess the activity and safety of alectinib as neoadjuvant treatment in surgically resectable stage III ALK-positive NSCLC: ALNEO trial","volume":"22","author":"Leonetti","year":"2021","journal-title":"Clin Lung Cancer"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMOA1709937\/SUPPL_FILE\/NEJMOA1709937_DISCLOSURES.PDF","article-title":"Durvalumab after chemoradiotherapy in stage III non\u2013small-cell lung cancer","volume":"377","author":"Antonia","year":"2017","journal-title":"New Engl J Med"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.21.01308\/ASSET\/IMAGES\/LARGE\/JCO.21.01308TA5.JPEG","article-title":"Five-year survival outcomes from the PACIFIC trial: durvalumab after chemoradiotherapy in stage III non-small-cell lung cancer","volume":"40","author":"Spigel","year":"2022","journal-title":"J Clin Oncol"},{"key":"B24","doi-asserted-by":"publisher","first-page":"893","DOI":"10.1016\/J.ANNONC.2022.06.013","article-title":"Immunotherapy in unresectable stage III non-small-cell lung cancer: state of the art and novel therapeutic approaches","volume":"33","author":"Cortiula","year":"2022","journal-title":"Ann Oncol"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.1016\/J.EJCA.2022.02.015","article-title":"Who benefits from consolidation durvalumab in stage III non-small cell lung cancer","volume":"167","author":"De Ruysscher","year":"2022","journal-title":"Eur J Cancer"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.1038\/NRCLINONC.2017.141","article-title":"Radiomics: the bridge between medical imaging and personalized medicine","volume":"14","author":"Lambin","year":"2017","journal-title":"Nat Rev Clin Oncol"},{"key":"B27","doi-asserted-by":"publisher","first-page":"S807","DOI":"10.21037\/JTD.2018.03.126","article-title":"A new approach to predict lymph node metastasis in solid lung adenocarcinoma: a radiomics nomogram","volume":"10","author":"Yang","year":"2018","journal-title":"J Thorac Dis"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.2214\/AJR.17.19074","article-title":"Radiomics approach to prediction of occult mediastinal lymph node metastasis of lung adenocarcinoma","volume":"211","author":"Zhong","year":"2018","journal-title":"AJR Am J Roentgenol"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.1007\/S00330-014-3420-6","article-title":"Quantitative CT texture and shape analysis: can it differentiate benign and Malignant mediastinal lymph nodes in patients with primary lung cancer","volume":"25","author":"Bayanati H","year":"2015","journal-title":"Eur Radiol"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.1177\/0284185115598808","article-title":"CT texture analysis can help differentiate between Malignant and benign lymph nodes in the mediastinum in patients suspected for lung cancer","volume":"57","author":"Andersen","year":"2016","journal-title":"Acta Radiol"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtho.2016.11.2226","article-title":"Radiomic-based pathological response prediction from primary tumors and lymph nodes in NSCLC","volume":"12","author":"Coroller","year":"2017","journal-title":"J Thorac Oncol"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.3390\/CANCERS14225700","article-title":"The multidisciplinary approach in stage III non-small cell lung cancer over ten years: from radiation therapy optimisation to innovative systemic treatments","volume":"14","author":"Ferro","year":"2022","journal-title":"Cancers (Basel)"},{"key":"B33","doi-asserted-by":"publisher","DOI":"10.1016\/j.neuroimage.2017.11.024","article-title":"Harmonization of cortical thickness measurements across scanners and sites","volume":"167","author":"Fortin","year":"2018","journal-title":"Neuroimage"},{"key":"B34","doi-asserted-by":"publisher","DOI":"10.3390\/diagnostics15151968","article-title":"RadiomiX for radiomics analysis: automated approaches to overcome challenges in replicability","volume":"15","author":"Kotler","year":"2025","journal-title":"Diagnostics (Basel)"},{"key":"B35","doi-asserted-by":"publisher","DOI":"10.1038\/s41591-022-01962-5","article-title":"Neoadjuvant atezolizumab for resectable non-small cell lung cancer: an open-label, single-arm phase II trial","volume":"28","author":"Chaft","year":"2022","journal-title":"Nat Med"},{"key":"B36","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2304875","article-title":"Perioperative durvalumab for resectable non-small-cell lung cancer","volume":"389","author":"Heymach","year":"2023","journal-title":"N Engl J Med"},{"key":"B37","doi-asserted-by":"publisher","DOI":"10.3390\/CANCERS16152673","article-title":"What does N2 lymph node involvement mean for patients with non-small cell lung cancer (NSCLC)?-A review of implications for diagnosis and treatment","volume":"16","author":"Linares D\u00edaz","year":"2024","journal-title":"Cancers (Basel)"},{"key":"B38","doi-asserted-by":"publisher","DOI":"10.1093\/ANNONC\/MDX222","article-title":"Early and locally advanced non-small-cell lung cancer (NSCLC): ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up","volume":"28","author":"Postmus","year":"2017","journal-title":"Ann Oncol"},{"key":"B39","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1007\/S12094-019-02134-7","article-title":"Multidisciplinary consensus statement on the clinical management of patients with stage III non-small cell lung cancer","volume":"22","author":"Majem","year":"2020","journal-title":"Clin Transl Oncol"},{"key":"B40","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1002\/CAC2.12505","article-title":"Management of locally advanced non-small cell lung cancer: State of the art and future directions","volume":"44","author":"Miao","year":"2024","journal-title":"Cancer Commun"},{"key":"B41","doi-asserted-by":"publisher","DOI":"10.1016\/J.ESMOOP.2024.103464","article-title":"Real-world outcomes with durvalumab after chemoradiotherapy in patients with unresectable stage III NSCLC: interim analysis of overall survival from PACIFIC-R","volume":"9","author":"Filippi","year":"2024","journal-title":"ESMO Open"},{"key":"B42","doi-asserted-by":"publisher","DOI":"10.1016\/J.EJCA.2023.113404","article-title":"Systematic review and meta-analysis of immune checkpoint inhibitors as single agent or in combination with chemotherapy in early-stage non-small cell lung cancer: Impact of clinicopathological factors and indirect comparison between treatment strategies","volume":"195","author":"Nuccio","year":"2023","journal-title":"Eur J Cancer"},{"key":"B43","doi-asserted-by":"publisher","DOI":"10.3390\/CANCERS16071302","article-title":"An updated review of management of resectable stage III NSCLC in the era of neoadjuvant immunotherapy","volume":"16","author":"Verma","year":"2024","journal-title":"Cancers (Basel)"},{"key":"B44","doi-asserted-by":"publisher","first-page":"E246837","DOI":"10.1001\/JAMANETWORKOPEN.2024.6837","article-title":"Neoadjuvant chemo-immunotherapy for early-stage non-small cell lung cancer: A systematic review and meta-analysis","volume":"7","author":"Banna","year":"2024","journal-title":"JAMA Netw Open"},{"key":"B45","doi-asserted-by":"publisher","first-page":"2400332","DOI":"10.1183\/13993003.00332-2024","article-title":"Surgically resectable nonsmall cell lung cancer: a contemporary approach","volume":"64","author":"D\u2019Amours","year":"2024","journal-title":"Eur Respir J"},{"key":"B46","doi-asserted-by":"publisher","DOI":"10.1016\/j.iotech.2022.100106","article-title":"1O IMpower010: ctDNA status in patients (pts) with resected NSCLC who received adjuvant chemotherapy (chemo) followed by atezolizumab (atezo) or best supportive care (BSC)","volume":"16","author":"Felip","year":"2022","journal-title":"Immuno-Oncol Technol"},{"key":"B47","doi-asserted-by":"publisher","DOI":"10.1200\/OP.20.00899","article-title":"Improving care for patients with stage III or IV NSCLC: learnings for multidisciplinary teams from the ACCC national quality survey","volume":"17","author":"Salgia","year":"2021","journal-title":"JCO Oncol Pract"},{"key":"B48","doi-asserted-by":"publisher","DOI":"10.1016\/J.JTOCRR.2023.100580","article-title":"Does multidisciplinary team management improve clinical outcomes in NSCLC? A systematic review with meta-analysis","volume":"4","author":"de Castro","year":"2023","journal-title":"JTO Clin Res Rep"},{"key":"B49","doi-asserted-by":"publisher","DOI":"10.3332\/ECANCER.2023.1605","article-title":"Role of digital health in coordinating patient care in a hub-and-spoke hierarchy of cancer care facilities: a scoping review","volume":"17","author":"Venkataramanan","year":"2023","journal-title":"Ecancermedicalscience"},{"key":"B50","doi-asserted-by":"publisher","DOI":"10.21037\/CCTS-20-128","article-title":"Management of stage IIIA non-small cell lung cancer in elderly patients: should we do differently?\u2014a narrative review","volume":"4","author":"Minervini","year":"2022","journal-title":"Curr Challenges Thorac Surg"},{"key":"B51","doi-asserted-by":"publisher","DOI":"10.1016\/J.ECLINM.2021.100990","article-title":"The effect of smoking status on efficacy of immune checkpoint inhibitors in metastatic non-small cell lung cancer: A systematic review and meta-analysis","volume":"38","author":"Dai","year":"2021","journal-title":"EClinicalMedicine"},{"key":"B52","doi-asserted-by":"publisher","DOI":"10.1371\/JOURNAL.PONE.0268288","article-title":"Prognostic value of the platelet-to-lymphocyte ratio in lung cancer patients receiving immunotherapy: A systematic review and meta-analysis","volume":"17","author":"Wang","year":"2022","journal-title":"PloS One"},{"key":"B53","doi-asserted-by":"publisher","first-page":"50","DOI":"10.3390\/JOR4010005","article-title":"Lung cancer staging\u2014A clinical practice review","volume":"4","author":"Rueschhoff","year":"2024","journal-title":"J Respir"},{"key":"B54","doi-asserted-by":"publisher","DOI":"10.3390\/cancers16111975","article-title":"CASCADE: context-aware data-driven AI for streamlined multidisciplinary tumor board recommendations in oncology","volume":"16","author":"Daye","year":"2024","journal-title":"Cancers (Basel)"},{"key":"B55","doi-asserted-by":"publisher","first-page":"614","DOI":"10.1038\/s41598-018-36938-4","article-title":"Assessing robustness of radiomic features by image perturbation","volume":"9","author":"Zwanenburg","year":"2019","journal-title":"Sci Rep"}],"container-title":["Frontiers in Oncology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2025.1713847\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,19]],"date-time":"2025-12-19T05:17:00Z","timestamp":1766121420000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2025.1713847\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,19]]},"references-count":55,"alternative-id":["10.3389\/fonc.2025.1713847"],"URL":"https:\/\/doi.org\/10.3389\/fonc.2025.1713847","relation":{},"ISSN":["2234-943X"],"issn-type":[{"value":"2234-943X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,19]]},"article-number":"1713847"}}