• Dong Tian, Hao-Ji Yan, Haruhiko Shiiya, Masaaki Sato, Aya Shinozaki-Ushiku, and Jun Nakajima.
• Department of Thoracic Surgery, The University of Tokyo Graduate School of Medicine, Tokyo, Japan; Heart and Lung Transplant Research Laboratory, Affiliated Hospital of North Sichuan Medical College, Nanchong, China; Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China.
• J. Thorac. Cardiovasc. Surg. 2023 Feb 1; 165 (2): 502516.e9502-516.e9.

ObjectiveFor patients with thymic epithelial tumors, accurately predicting clinicopathological outcomes remains challenging. We aimed to investigate the performance of machine learning-based radiomic computed tomography phenotyping for predicting pathological (World Health Organization [WHO] type and TNM stage) and survival outcomes (overall and progression-free survival) in patients with thymic epithelial tumors.MethodsThis retrospective study included patients with thymic epithelial tumors between January 2001 and January 2022. The radiomic features were extracted from preoperative unenhanced computed tomography images. After strict feature selection, random forest and random survival forest models were fitted to predict pathological and survival outcomes, respectively. The model performance was assessed by the area under the curve (AUC) and validated internally by the bootstrap method.ResultsIn total, 124 patients with a median age of 61 years were included. The radiomics random forest models of WHO type and TNM stage showed satisfactory performance with an AUCWHO of 0.898 (95% CI, 0.753-1.000) and an AUCTNM of 0.766 (95% CI, 0.642-0.886). For overall survival and progression-free survival prediction, the radiomics random survival forest models showed good performance (integrated AUCs, 0.923; 95% CI, 0.691-1.000 and 0.702; 95% CI, 0.513-0.875, respectively), and the integrated AUCs increased to 0.935 (95% CI, 0.705-1.000) and 0.811 (95% CI, 0.647-0.942), respectively, when combined with clinicopathological features.ConclusionsMachine learning-based radiomic computed tomography phenotyping might allow for the satisfactory prediction of pathological and survival outcomes and further improve prognostic performance when integrated with clinicopathological features in patients with thymic epithelial tumors.Copyright © 2022 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

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