Radiology-Report Semantic Modelling and Host-Response Laboratory Biomarkers for Multimodal Survival Prediction in Lung Cancer

Abstract

TNM staging is essential for lung cancer management, but patients within the same anatomic stage often show heterogeneous survival outcomes. We developed a multimodal adaptive risk score (AMRS) that integrates radiology-report semantics with routinely available clinical laboratory biomarkers. In a retrospective two-center cohort, 1129 patients diagnosed between December 2017 and February 2026 were screened; 574 patients were included after exclusion for short follow-up or missing imaging reports and were split into training (n = 459) and test (n = 115) cohorts. Radiology reports were encoded with a domain-adapted MC-BERT branch to capture imaging-derived semantic information, while clinical and laboratory variables were modeled after Mahalanobis-distance-based imputation using random survival forests. Weighted risk fusion generated the final patient-level score. AMRS achieved C-index values of 0.920 in training and 0.849 in testing, and separated survival trajectories across clinical subgroups and TNM-related strata. SHAP analysis identified hematologic, inflammatory, coagulation, nutritional, tumor-marker, organ-function, and age-related contributors. AMRS may complement TNM staging in imaging-centered oncology workflows, but prospective validation, calibration, ablation testing, and clinical-utility assessment are required before deployment.