Prediction of Tumor PD-L1 Expression in Resectable Non-Small Cell Lung Cancer by Machine Learning Models Based on Clinical and Radiological Features: Performance Comparison With Preoperative Biopsy

Objective We investigated if PD-L1 expression can be predicted by machine learning using clinical and imaging features. Methods We included 117 patients with c-stage I/II non-small cell lung cancer who underwent radical resection. A total of 3951 radiomic features were extracted by defining the tumor (within tumor contour), rim (contour ±3 mm) and exterior (contour +10 mm) on preoperative contrast computed tomography. After feature selection by Boruta algorithm, prediction models of tumor PD-L1 expression (22C3: ≥1%, <1%) of resected specimens were constructed using Random Forest: radiomics, clinical, and combined models. Their performance was evaluated by five-fold cross-validation, and AUCs were compared using Delong test. Next, study groups were categorized as patients without biopsy (training set), and those with biopsy (test set). Predictive ability of biopsy was compared to each prediction model. Results Of 117 patients (66 ± 10 years old, 48% male), 33 (28.2%) had PD-L1≥1%. Mean AUC of PD-L1≥1% for the validation set in radiomics, clinical, and combined models were 0.80, 0.80, and 0.83 (p=0.32 vs. clinical model), respectively. The diagnosis of malignancy was made in 22/38 (58%) patients with attempted biopsies, and PD-L1 was measurable in 19/38 (50%) patients. Diagnostic accuracies of PD-L1≥1% from 19 determinable biopsies and 38 all attempted biopsies were 0.68 and 0.34, respectively. These were outperformed by machine learning: 0.71, 0.71, and 0.74 for radiomics, clinical, and combined models, respectively. Conclusions Our machine learning could be an adjunctive tool in estimating PD-L1 expression prior to neoadjuvant treatment, particularly when PD-L1 is indeterminable with biopsy. MiniAbstract We included 117 patients with c-stage I/II non-small cell lung cancer who underwent radical resection.Machine learning models, using clinical and radiomics features, predicted tumor PD-L1 expression in resected specimens (AUC=0.83) with a higher predictive ability than that of preoperative biopsy.Our machine learning could be an adjunctive tool in estimating PD-L1 expression prior to neoadjuvant treatment.