The functional status of CD8 + T cells is a key factor influencing the prognosis in patients with non–small cell lung cancer (NSCLC). We aimed to develop a radiomics model predicting the functional state of tumor-infiltrating CD8 + T cells in NSCLC, explore semantic characteristics linking radiomic features to CD8 + T cell exhaustion, and establish a prognostic nomogram. A retrospective cohort of 256 patients with NSCLC undergoing radical resection with CD8 + T cell functional status determined by multiplex immunofluorescence staining was randomly divided 7:3 into training and validation sets. Radiomic features from preoperative contrast-enhanced CT scans were used to develop predictive models for high density of tumor center pre-dysfunctional CD8 + T cells (high-T pre ) and high density of invasive margin dysfunctional CD8 + T cells (high-T dys ) through least absolute shrinkage and selection operator, followed by semantic analysis. A nomogram for predicting recurrence-free survival integrated radiomics models with clinical characteristics. Only the high-T dys radiomics model was successfully established, yielding areas under the curve of 0.933 (training) and 0.792 (validation). Peritumoral imaging features on contrast-enhanced CT (fibrosis, inflammation, and atelectasis) were associated with CD8 + T cell exhaustion, evidenced by significantly higher high-T dys proportions: 31.6% vs. 7.5% ( P < 0.001), 35.6% vs. 8.1% ( P < 0.001), and 40.0% vs. 11.8% ( P = 0.028). The nomogram incorporating high-T dys radiomics score, T stage, and N stage predicted 1- to 4-year predicting recurrence-free survival with areas under the curve of 0.733, 0.713, 0.637, and 0.600 (training), and 0.629, 0.669, 0.550, and 0.593 (validation). Radiomics can predict the functional exhaustion of tumor-infiltrating CD8 + T cells in NSCLC, with specific imaging features associated with this process. Combining the radiomics model with clinical characteristics facilitates the assessment of patient prognosis.
Sang et al. (Sun,) studied this question.