Associations between Radiomics and Genomics in Non-Small Cell Lung Cancer Utilizing Computed Tomography and Next-Generation Sequencing: An Exploratory Study

Background: Radiomics, an evolving paradigm in medical imaging, involves the quantitative analysis of tumor features and demonstrates promise in predicting treatment responses and outcomes. This study aims to investigate the predictive capacity of radiomics for genetic alterations in non-small cell lung cancer (NSCLC). Methods: This exploratory, observational study integrated radiomic perspectives using computed tomography (CT) and genomic perspectives through next-generation sequencing (NGS) applied to liquid biopsies. Associations between radiomic features and genetic mutations were established using the Area Under the Receiver Operating Characteristic curve (AUC-ROC). Machine learning techniques, including Support Vector Machine (SVM) classification, aim to predict genetic mutations based on radiomic features. The prognostic impact of selected gene variants was assessed using Kaplan–Meier curves and Log-rank tests. Results: Sixty-six patients underwent screening, with fifty-seven being comprehensively characterized radiomically and genomically. Predominantly males (68. 4%), adenocarcinoma was the prevalent histological type (73. 7%). Disease staging is distributed across I/II (38. 6%), III (31. 6%), and IV (29. 8%). Significant correlations were identified with mutations of ROS1 p. Thr145Pro (shapeSphericity), ROS1 p. Arg167Gln (glszmZoneEntropy, firstorderTotalEnergy), ROS1 p. Asp2213Asn (glszmGrayLevelVariance, firstorderRootMeanSquared), and ALK p. Asp1529Glu (glcmImc1). Patients with the ROS1 p. Thr145Pro variant demonstrated markedly shorter median survival compared to the wild-type group (9. 7 months vs. not reached, p = 0. 0143; HR: 5. 35; 95% CI: 1. 39–20. 48). Conclusions: The exploration of the intersection between radiomics and cancer genetics in NSCLC is not only feasible but also holds the potential to improve genetic predictions and enhance prognostic accuracy.