Transformer-Based Preoperative Invasiveness Identification and Postoperative Recurrence Risk Stratification in Stage T1N0M0 Lung Adenocarcinoma: A Multi-Center Cohort Study.

Surgery is the primary curative treatment for early-stage lung adenocarcinoma (LUAD), with accurate identification of tumor invasiveness critical for determining pulmonary resection extent. Due to significant variability in postoperative recurrence among early-stage LUAD patients with aggressive tumors, a more effective risk stratification system is urgently needed to improve prognosis. This study developed the T1LUT system, a transformer-based tool for T1N0M0 LUAD management, covering preoperative tumor invasiveness identification and postoperative recurrence risk stratification. Preoperatively, a 3D Vision Transformer (ViT) with extra learnable tokens analyzes CT images. It outperforms 3D ViT with only CLS tokens, 2D ViT, and 3D ResNet across three independent test centers (Center D: 0.896 vs. 0.892, 0.879, 0.836; Center E: 0.906 vs. 0.837, 0.837, 0.835; Center F: 0.884 vs. 0.884, 0.881, 0.861), achieving higher mean AUROC to accurately assess invasiveness and guide surgical resection extent. Postoperatively, the multimodal IAC-PR model integrates CT images, reports, pathological data, and clinical/demographic information. It stratifies invasive adenocarcinoma (IAC) patients into low-, medium-, or high-risk groups with an AUROC of 0.807 in testing-significantly better than single/partial-modal models. Validated via large-scale multicenter research, this system overcomes traditional assessment limitations, offering a robust tool for precise early LUAD treatment and improved prognosis.