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BackgroundNon-small cell lung cancer (NSCLC) is the most common type of lung cancer, and the median overall survival is approximately 2-3 years among patients with stage III disease. Furthermore, it is one of the deadliest types of cancer globally due to non-specific symptoms and the lack of a biomarker for early detection. The most important decision that clinicians need to make after a lung cancer diagnosis is the selection of a treatment schedule. This decision is based on, among others factors, the risk of developing metastasis.MethodsA cohort of 115 NSCLC patients treated using chemotherapy and radiotherapy with curative intent was retrospectively collated and included patients for whom positron emission tomogra-phy/computed tomography (PET/CT) images, acquired before radiotherapy, were available. The PET/CT images were used to compute radiomic features extracted from a region of interest, the primary tumor. Radiomic and clinical features were then classified to stratify the patients into short and long time to metastasis, and regression analysis was used to predict the risk of metastasis.ResultsClassification based on binarized metastasis-free survival (MFS) was applied with moderate success. Indeed, an accuracy of 0.73 was obtained for the selection of features based on the Wilcoxon test and logistic regression model. However, the Cox regression model for metastasis risk prediction performed very well, with a concordance index (c-index) score equal to 0.84.ConclusionsIt is possible to accurately predict the risk of metastasis in NSCLC patients based on radiomic features. The results demonstrate the potential use of features extracted from cancer imaging in predicting the risk of metastasis.