A Nomogram Based on CT Deep Learning Signature: A Potential Tool for the Prediction of Overall Survival in Resected Non-Small Cell Lung Cancer Patients

To develop and further validate a deep learning signature-based nomogram from computed tomography (CT) images for prediction of the overall survival (OS) in resected non-small cell lung cancer (NSCLC) patients.A total of 1792 deep learning features were extracted from non-enhanced and venous-phase CT images for each NSCLC patient in training cohort (n=231). Then, a deep learning signature was built with the least absolute shrinkage and selection operator (LASSO) Cox regression model for OS estimation. At last, a nomogram was constructed with the signature and other independent clinical risk factors. The performance of nomogram was assessed by discrimination, calibration and clinical usefulness. In addition, in order to quantify the improvement in performance added by deep learning signature, the net reclassification improvement (NRI) was calculated. The results were validated in external validation cohort (n=77).A deep learning signature with 9 selected features was significantly associated with OS in both training cohort (hazard ratio [HR]=5.455, 95% CI: 3.393-8.769, P<0.001) and external validation cohort (HR=3.029, 95% CI: 1.673-5.485, P=0.004). The nomogram combining deep learning signature with clinical risk factors of TNM stage, lymphatic vessel invasion and differentiation grade showed favorable discriminative ability with C-index of 0.800 as well as a good calibration, which was validated in external validation cohort (C-index=0.723). Additional value of deep learning signature to the nomogram was statistically significant (NRI=0.093, P=0.027 for training cohort; NRI=0.106, P=0.040 for validation cohort). Decision curve analysis confirmed the clinical usefulness of this nomogram in predicting OS.The deep learning signature-based nomogram is a robust tool for prognostic prediction in resected NSCLC patients.