Objective To explore the prognostic value of quantitative parameters of intra-voxel incoherent motion-diffusion weighted imaging (IVIM-DWI) in predicting the prognosis of patients with Kirsten rats arcomaviral oncogene homolog (KRAS) mutation non-small cell lung cancer (NSCLC) undergoing first-line concurrent chemoradiotherapy.

Methods A total of 139 patients with KRAS-mutated NSCLC were selected as the research subjects, and all of them received first-line concurrent chemoradiotherapy. Based on follow-up results (with all-cause mortality within one year defined as the endpoint event), patients were divided into favorable prognosis group and poor prognosis group. General data and IVIM-DWI quantitative parametersapparent diffusion coefficient (ADC), diffusion coefficient (D), pseudo-diffusion coefficient (D^*) and perfusion fraction (f)were compared between the two groups. Cox regression analysis was employed to identify factors influencing poor prognosis in patients with KRAS-mutated NSCLC. Receiver operating characteristic (ROC) curves were plotted to evaluate the prognostic predictive value of IVIM-DWI quantitative parameters. Kaplan-Meier (K-M) survival curves and the Log-rank test were used to analyze the relationships between IVIM-DWI quantitative parameters and prognosis in patients with KRAS-mutated NSCLC.

Results Among the 139 patients, four were lost during follow-up, resulting in a survival rate of 69.63% (94/135). The favorable prognosis group comprised 94 patients, while the poor prognosis group included 41 patients. There were statistically significant differences in the types of KRAS mutations, the best therapeutic effect after treatment, and smoking history between the two groups (P < 0.05). After adjusting for confounding factors, ADC, D, D^* and f values were identified as influencing factors for poor prognosis in patients with KRAS-mutated NSCLC (P < 0.05). The area under the curve (AUC) for the combined prediction of prognosis using ADC, D, D^* and f values was 0.933, which was higher than the AUC for each parameter alone. Patients with low ADC, D, D^* and f values exhibited significantly lower survival rates compared to those with high values (P < 0.05).

Conclusion IVIM-DWI quantitative parameters, including ADC, D, D^* and f values, are influencing factors for the prognosis of first-line concurrent chemoradiotherapy in patients with KRAS-mutated NSCLC. The combined predictive performance of these parameters is high, offering guidance for clinical diagnosis and treatment and potentially improving disease prognosis.