## 3 Discussion
### Radomics and Artificial Intelligence
[35] performed a radiomic analysis to predict tumor response in mRCC patients treated with nivolumab [35]. Forty-eight patients--the same group of patients as in the previously described study--were included in the study, 46 (95%) of whom had previously received VEGF inhibitor treatment, and 39 patients (60.4%) were considered responders according to the RECIST 1.1 criteria. The k-nearest neighbor, support-vector machine based on linear kernel, random forest, and logistic regression predictive models were built using four supervised machine learning algorithms. Radiomic analysis demonstrated the accuracy scores of the k-nearest neighbor, random forest, logistic regression, and support-vector machine predictive models to be 0.82, 0.71, 0.91, and 0.81, respectively, with area under the receiver operating characteristic curve scores of 0.79, 0.67, 0.92, and 0.71, respectively. The results of this study were promising for the identification of responders by pretreatment radiomic analysis, demonstrating how the model could predict response to treatment in over 90% of patients [35]. [PERSON] et al. [11] conducted a radiomic analysis to predict oncological outcomes in mRCC patients treated with ICIs [11]. Sixty-eight patients were included in this study, most of whom were categorized as being in the intermediate IMDC risk group (n = 39; 57.4%), followed by poor IMDC risk (n = 20; 29.4%) and favorable IMDC risk (n = 9; 13.2%). The median overall survival was 21.5 months (95% CI, 10.5-32.5 months), while the median progression-free survival was 5.2 months (2.0-8.4 months). CT texture analysis was performed on 298 lesions of 68 patients, including lymph node (n = 97; 32.6%), pulmonary (n = 51; 17.1%), hepatic (n = 41; 13.8%), peritoneal (n = 40; 13.4%), adrenal (n = 22; 7.4%), renal (n = 17; 5.7%), pancreatic (n = 11; 3.7%), intramuscular (n = 10; 3.4%), and pleural (n = 9; 3.0%) lesions. From the training datasets, a median threshold survival index was obtained to classify patients as high-risk and low-risk. The baseline texture model showed a median overall survival of 60.1 months in the low-risk group (95% CI, 19.6-not reached) and 17.0 months in the high-risk group (95% CI, 11.9-32.8) (\(p\) = 0.048), while the follow-up texture model showed a median overall survival of 40.3 months in the low-risk group (95% CI, 21.7-not reached) and 15.2 months in the high-risk group (95% CI, 11.1-32.3) (\(p\) = 0.008). The baseline texture model managed to distinguish shorter from longer progression-free survival patients, while the follow-up texture models failed. The baseline texture model showed a median progression-free survival of 5.2 months in the low-risk group (95% CI, 3.6-23.8) and 2.8 months in the high-risk group (95% CI, 1.7-7.6) (\(p\) = 0.003), while the follow-up texture model showed a median progression-free survival of 5.0 months in the low-risk group (95% CI, 3.5-11.9) and 3.6 months in the high-risk group (95% CI, 2.4-7.6) (\(p\) = 0.025). In a subgroup of the 32 patients treated with ICI as a first-line therapy, the baseline texture model for overall survival and progression-free survival distinguished between longer-term survivors and shorter-term survivors (median OS, not reached vs. 16.8 months (95% CI, 2.9-30.7), \(p\) = 0.03; median PFS, 11.7 months (95% CI, 4.5-33.6) vs. 3.8 months (95% CI, 1.4-7.8), \(p\) = 0.004), while the follow-up texture models for overall survival distinguished between longer-term survivors and shorter-term survivors (median OS, 39.7 months vs. 9.8 months (95% CI, 0.1-19.5), \(p\) = 0.002), but not for progression-free survival (\(p\) = 0.53). Univariate analysis showed that the baseline and follow-up texture models had significant association with overall survival (HR, 2.05 [95% CI, 1.07-3.94] and 2.65 [95% CI, 1.38-5.11], respectively. Univariate analysis showed that the baseline texture models had significant associations with progression-free survival (HR, 1.84; 95% CI, 1.08-3.12), but not for the follow-up texture analysis (HR, 1.30; 95% CI, 0.77-2.19) [11].