prediction of EGFR mutation and response to the targeted therapy in NSCLC). “Radiomics,” an emerging tool that provides quantitative imaging parameters, has been applied in oncology for tumor assessment and evaluation of the patient's response to treatment (e.g. 12, 13 However, these studies focused primarily on qualitative imaging features with study populations that were limited to early stage, resectable lung adenocarcinomas therefore, quantitative analysis may be more valuable. Previous studies have investigated the relationship between CT image features and PD‐L1 expression. The prediction of PD‐L1 expression from computed tomography (CT) imaging features may have value, not only for predicting patient outcome by imaging, but also in situations where tissue sampling is not possible. 8, 9, 10 In this context, the International Association for the Study of Lung Cancer (IASLC) provided an atlas of PD‐L1 immunohistochemistry testing in NSCLC. 5, 6, 7 As immunotherapy became one of the standard treatment regimens for NSCLC, biomarkers for predicting responses to immune checkpoint inhibitors were investigated and PD‐L1 expression on tumor cells was accepted as a predictive biomarker for the immunotherapy response.
Recently, immune checkpoint inhibitors targeting programmed cell death protein 1 (PD‐1) or programmed death ligand 1 (PD‐L1) have demonstrated better progression‐free and overall survival than conventional chemotherapy in advanced non‐small cell lung cancer (NSCLC) patients. However, recent developments in molecular‐targeted therapy has significantly improved survival to subsets of patients who are positive for genetic alteration such as mutation in the epidermal growth factor receptor ( EGFR) gene and rearrangement of the anaplastic lymphoma kinase gene locus. 1, 2 In the past, platinum‐based conventional chemotherapy was the only option for treating advanced lung adenocarcinoma. Lung cancer is the leading cause of cancer‐related deaths worldwide, and adenocarcinoma is the most common histologic type of lung cancer.
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