PET/CT-derived whole-body composition and survival in resectable NSCLC: double machine learning-based adjusted association analysis of intermuscular adiposity burden and sex-specific metabolic phenotypes.

Zhai W, Wang R, Ye M, +6 more, Fan L.

Multicenter StudyOpen access

AI summary — for doctors, generated from the abstract only

Higher intermuscular fat on PET/CT was associated with shorter survival in resectable NSCLC.

What was studied

Retrospective multicenter study of 769 patients with automated body composition segmentation and double machine learning.

Key findings

Higher IMAT volume index linked to shorter OS (-4.29 months) and PFS (-2.74 months)
Exploratory favorable association of TAT SUR with OS (+4.42 months)
Sex-specific patterns; modest incremental value

Clinical relevance

Suggests body composition as a prognostic marker.

Who should care

Radiodiagnosis/Radiology

Limitations

Retrospective with modest incremental value.

Research setting only.

This is an AI-generated summary of the published abstract, not a clinical recommendation. It may not reflect the full text or subsequent updates — verify against the original source before acting on it.

Abstract

Purpose

To evaluate whether whole-body PET/CT-derived body composition features are associated with survival in patients with resectable non-small cell lung cancer (NSCLC), using double machine learning to quantify adjusted associations with restricted mean survival time.

Methods

This retrospective multicenter study included 769 patients with stage ≤ IIIA NSCLC who underwent preoperative 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) and curative resection. Center 1 was used for model development (n = 555) and Center 2 for external validation (n = 214). Automated whole-body segmentation was used to extract volumetric, attenuation-based and metabolic features of skeletal muscle and adipose tissue. Restricted mean survival time-based double machine learning with generalized propensity score weighting estimated DML-adjusted differences in restricted mean survival time for overall survival (OS) and progression-free survival (PFS). Ridge-penalized Cox models were further used to evaluate prognostic performance and incremental value.

Results

Higher intermuscular adipose tissue (IMAT) volume index was associated with shorter survival (DML-adjusted RMST difference, -4.29 months for OS and - 2.74 months for PFS per 1-SD higher IMAT volume index). Higher TAT SUR (Mean) showed an exploratory favorable adjusted association with longer OS (+ 4.42 months). Sex-stratified analyses suggested stronger adverse adipose-volume associations in male patients and stronger favorable adipose-metabolic associations in female patients. Model analyses showed moderate external discrimination, whereas incremental-value metrics were modest and endpoint-dependent.

Conclusion

Whole-body PET/CT body-composition phenotyping may provide prognostic information in resectable NSCLC. Higher IMAT burden was associated with shorter survival, whereas TAT SUR (Mean) showed an exploratory favorable adjusted association with OS. A local software framework may support reproducible feature extraction and research-oriented risk stratification.

DOI

10.1007/s00259-026-08098-5

PMID

42501072

Research metadata (titles, abstracts, authors, publication dates) is sourced from Europe PMC, which aggregates content from PubMed/MEDLINE, PubMed Central, and other providers under the U.S. National Library of Medicine (NLM/NCBI). NLM does not claim copyright on abstracts; the original journal publishers or authors may hold rights to the full articles. AI-generated summaries are derived only from the abstract, never the full text, and are always labeled as AI-generated.

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