{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T18:47:59Z","timestamp":1790362079611,"version":"4.1.0"},"reference-count":38,"publisher":"MDPI AG","issue":"23","license":[{"start":{"date-parts":[[2025,11,28]],"date-time":"2025-11-28T00:00:00Z","timestamp":1764288000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background\/Objectives: Neuroendocrine tumors (NETs) of the lung account for about 30% of NETs. In localized and locally advanced forms, radical surgical resection is the standard of care. Although considered indolent tumors, they appear to be susceptible to post-surgical recurrence, with rates differing between typical and atypical carcinoid. Although still debated, several clinicopathologic factors are potentially associated with recurrence. The aim of this retrospective\/prospective observational study is to evaluate the predictive role of clinicopathological factors and radiomics features in patients with NET of the lung. Methods: From January 2021 to April 2024, 45 consecutive patients who underwent radical (R0) surgery for lung NET at the ENETS Center of Excellence of the Sant\u2019Andrea Hospital were enrolled, all with at least 12 months of postoperative follow-up and availability of preoperative unenhanced chest CT. Clinicopathologic and radiomic factors were considered (107 radiomic features). Of the individual characteristics, the impact on recurrence was assessed by univariate logistic regression. Results: Among the 45 patients included, 4 patients (8.9%) experienced disease recurrence. Among the clinicopathological features, major age at diagnosis (p = 0.020), atypical carcinoid (p = 0.010), presence of functional syndrome (p = 0.002), advanced stage at diagnosis (p = 0.013), necrosis (p = 0.017) higher Ki-67 (p = 0.001), higher mitotic count (p = 0.006), and pathologic lymph node (p = 0.006) were associated with disease recurrence. Three radiomic features were found to predict recurrence: DependenceEntropy (p = 0.049), DependenceNonUniformityNormalized (p = 0.024), and Elongation (p = 0.039). In this preliminary analysis, multivariate analysis was not performed due to the small sample size. Conclusions: This study has shown that radiomics can be a valuable tool in predicting recurrence. Currently, to our knowledge, no other studies on the possible application of radiomics as prognostic factors in patients with lung NET have been published. These encouraging findings warrant further investigations with larger, multicenter cohorts to validate these results and implement them by constructing a predictive model of recurrence.<\/jats:p>","DOI":"10.3390\/cancers17233812","type":"journal-article","created":{"date-parts":[[2025,11,28]],"date-time":"2025-11-28T08:26:57Z","timestamp":1764318417000},"page":"3812","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Radiomic and Clinical\u2013Pathological Factors Predictive of Postoperative Recurrence in Lung Neuroendocrine Tumors: A Pilot Study"],"prefix":"10.3390","volume":"17","author":[{"given":"Piero","family":"Paravani","sequence":"first","affiliation":[{"name":"Endocrinology Unit, Department of Clinical and Molecular Medicine, Sapienza University of Rome, Sant\u2019Andrea Hospital, ENETS Center of Excellence, 00189 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7331-6901","authenticated-orcid":false,"given":"Michela","family":"Polici","sequence":"additional","affiliation":[{"name":"Radiology Unit, Department of Medical Surgical Sciences and Translational Medicine, Sapienza University of Rome, Sant\u2019Andrea Hospital, 00189 Rome, Italy"},{"name":"PhD School in Traslational Medicine and Oncology, Department of Medical and Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology, Sapienza University of Rome, 00185 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0541-415X","authenticated-orcid":false,"given":"Giulia","family":"Arrivi","sequence":"additional","affiliation":[{"name":"Oncology Unit, Department of Clinical and Molecular Medicine, Sapienza University of Rome, Sant\u2019 Andrea Hospital, 00189 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandra","family":"Siciliani","sequence":"additional","affiliation":[{"name":"Division of Thoracic Surgery, Department of Medical and Surgical Sciences and Translational Medicine, Sapienza University of Rome, Sant\u2019Andrea Hospital, 00189 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7465-2229","authenticated-orcid":false,"given":"Massimiliano","family":"Mancini","sequence":"additional","affiliation":[{"name":"Morphologic and Molecular Pathology Unit, Sant\u2019Andrea Hospital, 00189 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rossella","family":"Mazzilli","sequence":"additional","affiliation":[{"name":"Endocrinology Unit, Department of Clinical and Molecular Medicine, Sapienza University of Rome, Sant\u2019Andrea Hospital, ENETS Center of Excellence, 00189 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Virginia","family":"Zamponi","sequence":"additional","affiliation":[{"name":"Endocrinology Unit, Department of Clinical and Molecular Medicine, Sapienza University of Rome, Sant\u2019Andrea Hospital, ENETS Center of Excellence, 00189 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-9738-1070","authenticated-orcid":false,"given":"Maurizio","family":"Martiradonna","sequence":"additional","affiliation":[{"name":"Endocrinology Unit, Department of Clinical and Molecular Medicine, Sapienza University of Rome, Sant\u2019Andrea Hospital, ENETS Center of Excellence, 00189 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-8871-5947","authenticated-orcid":false,"given":"Federica","family":"Palmeri","sequence":"additional","affiliation":[{"name":"Radiology Unit, Department of Medical Surgical Sciences and Translational Medicine, Sapienza University of Rome, Sant\u2019Andrea Hospital, 00189 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3786-5716","authenticated-orcid":false,"given":"Beatrice","family":"Trabalza Marinucci","sequence":"additional","affiliation":[{"name":"Division of Thoracic Surgery, Department of Medical and Surgical Sciences and Translational Medicine, Sapienza University of Rome, Sant\u2019Andrea Hospital, 00189 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2789-4289","authenticated-orcid":false,"given":"Francesco","family":"Panzuto","sequence":"additional","affiliation":[{"name":"Department of Medical-Surgical Sciences and Translational Medicine, Sapienza University of Rome, Digestive Disease Unit, ENETS Center of Excellence, Sant\u2019Andrea University Hospital, 00189 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matteo","family":"Tiracorrendo","sequence":"additional","affiliation":[{"name":"Division of Thoracic Surgery, Department of Medical and Surgical Sciences and Translational Medicine, Sapienza University of Rome, Sant\u2019Andrea Hospital, 00189 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"D\u2019Andrilli","sequence":"additional","affiliation":[{"name":"Division of Thoracic Surgery, Department of Medical and Surgical Sciences and Translational Medicine, Sapienza University of Rome, Sant\u2019Andrea Hospital, 00189 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohsen","family":"Ibrahim","sequence":"additional","affiliation":[{"name":"Division of Thoracic Surgery, Department of Medical and Surgical Sciences and Translational Medicine, Sapienza University of Rome, Sant\u2019Andrea Hospital, 00189 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9285-4764","authenticated-orcid":false,"given":"Damiano","family":"Caruso","sequence":"additional","affiliation":[{"name":"Radiology Unit, Department of Medical Surgical Sciences and Translational Medicine, Sapienza University of Rome, Sant\u2019Andrea Hospital, 00189 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9324-3946","authenticated-orcid":false,"given":"Antongiulio","family":"Faggiano","sequence":"additional","affiliation":[{"name":"Endocrinology Unit, Department of Clinical and Molecular Medicine, Sapienza University of Rome, Sant\u2019Andrea Hospital, ENETS Center of Excellence, 00189 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,11,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"3063","DOI":"10.1200\/JCO.2007.15.4377","article-title":"One hundred years after \u201ccarcinoid\u201d: Epidemiology of and prognostic factors for neuroendocrine tumors in 35,825 cases in the United States","volume":"26","author":"Yao","year":"2008","journal-title":"J. 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