Survival Prediction for Postoperative Patients With Kidney Cancer Based on Computed Tomography Radiomics: Retrospective Cohort Study.

Background: Kidney cancer remains a significant challenge in oncology, with accurate prognostic assessment being crucial for postoperative management. While radiomics has shown promise in cancer prognosis, there is limited research on comprehensive models that effectively integrate radiomic features with clinical parameters for kidney cancer survival prediction. Objective: This study aimed to develop and validate a comprehensive computed tomography (CT) radiomics-based nomogram for predicting overall survival in postoperative patients with kidney cancer by integrating radiomic features with clinical parameters. Methods: Radiomic features were extracted from regions of interest in CT images of 207 postoperative patients with kidney cancer. The eigenvalue data of all radiomic features were processed using z score standardization and the R software package GLMNet. We integrated survival time, survival status, and radiomic features and screened these features using the least absolute shrinkage and selection operator-Cox regression method. We conducted 10-fold cross-validation to obtain an optimal model of 5 radiomic features. Multivariate Cox regression hazard models were established to analyze patients' overall survival. The predictive ability of the nomogram (receiver operating characteristic curve and calibration curve) was evaluated using bootstrap resampling validation. Patients were divided into high- and low-risk groups based on the radiomic risk score cutoff value, and the Kaplan-Meier method was conducted to identify established models' forecasting ability. Five radiomic features were screened for predictive model construction. Results: This retrospective analysis was conducted from April 2024 to July 2024 using data from The Cancer Imaging Archive public database. The final cohort included 207 patients (3 excluded from the initial 210) who underwent nephrectomy for kidney cancer. The median follow-up time was 33 (IQR 11-47) months. The receiver operating characteristic curve and area under the curve showed that the predictive model performed well. The calibration curve of nomogram and radiomic features in the cohort study set indicated an overall net benefit. Kaplan-Meier curves indicated that overall survival time was dramatically shorter in the high-risk group. Conclusions: Our radiomics nomogram successfully integrates CT-derived radiomic features with clinical variables for kidney cancer survival prediction, demonstrating good prognostic capability and offering a noninvasive, quantitative tool for personalized postoperative management and clinical decision-making.