Radiomics Model for Predicting FOXP3 Expression Level and Survival in Clear Cell Renal Carcinoma

Rationale and Objectives: We aimed to evaluate the predictive significance of forkhead box protein 3 ( FOXP3 ) expression levels among individuals with clear cell renal carcinoma (ccRCC) and establish a radiomics model for predicting FOXP3 expression. Materials and Methods: 430 patients with ccRCC were included in the gene-based prognostic analyses; 100 samples were used for radiomics feature generation, model development, and evaluation. A gradient boosting machine was employed to model the selected radiomics features. The developed model generated radiomics scores (RS) that predicted FOXP3 expression. The FOXP3 prognostic model combining imaging features was applied for survival and clinical indicator correlation analyses. Results: FOXP3 was highly expressed in patients with ccRCC and served as an independent predictive marker (hazard ratio [HR] = 2.357, 95% CI [confidence interval]: 1.582-3.511, p < 0.001). The radiomics model formed by three radiomics characteristics was identified as a strong prognostic indicator of overall survival (OS). The predictive power of the model was commendable (areas under the curve: 0.835 and 0.809 for training and validation sets, respectively). Significant between-group variations in RS distribution were identified, as indicated by gene expression levels ( p < 0.05). Disparities were observed in pathological stage, pharmaceutical therapy, and neoplasm status between low and high RS cohorts ( p < 0.001). Kaplan-Meier curves revealed a significant correlation between increased RS and decreased OS ( p = 0.001), which was also observed in the multivariate analyses (HR=3.411, 95% CI: 1.039-11.196, p = 0.043). Conclusion: Prognostic outcome of ccRCC is closely linked to FOXP3 expression level. Computed tomography-based radiomics shows promise for prognostic prediction in ccRCC.