Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Department of Radiology, Hallym University College of Medicine, Kangnam Sacred Heart Hospital, Seoul, Republic of Korea.
Acta Radiol. 2021 Dec;62(12):1548-1558. doi: 10.1177/0284185120971844. Epub 2020 Nov 16.
Repeated transarterial chemoembolization (TACE) can be associated with loss of its efficacy and subsequent tumor progression.
To identify features of gadoxetic acid-enhanced magnetic resonance imaging (MRI) associated with TACE refractoriness and to develop a prediction model for estimating the risk of TACE refractoriness.
Among 1025 patients with intermediate-stage hepatocellular carcinoma (HCC) who underwent TACE as a first-line treatment during 2010-2017, 427 patients who underwent preoperative gadoxetic acid-enhanced MRI were analyzed. According to the date of initial TACE, patients were divided into the development cohort (n = 211) and the test cohort (n = 216). TACE refractoriness was determined according to the Japan Society of Hepatology guidelines. Univariable and multivariable analyses were performed to investigate the association between clinical/MRI features and TACE refractoriness. The performance of the prediction model was internally and externally assessed using the C-index of discrimination and a Hosmer-Lemeshow goodness-of-fit test for calibration.
By analyzing 427 patients, we constructed a prediction model with the following independent features associated with TACE refractoriness: maximum tumor size; tumor number; peritumoral hypointensity on hepatobiliary phase (HBP); and the presence of non-hypervascular hypointense nodule on HBP. This system enabled the prediction of TACE refractoriness in the development cohort (C-index, 0.796) and the test cohort (C-index, 0.738) with good discrimination and calibration abilities.
The prediction model based on gadoxetic acid-enhanced MRI features in addition to the known predictors including tumor size and number can be used to estimate the risk of TACE refractoriness in patients with intermediate-stage HCC.
反复经动脉化疗栓塞（TACE）可能会导致疗效丧失和随后的肿瘤进展。
确定与 TACE 耐药相关的钆塞酸增强磁共振成像（MRI）特征，并建立预测模型来估计 TACE 耐药的风险。
在 2010 年至 2017 年间，1025 例接受 TACE 作为一线治疗的中晚期肝细胞癌（HCC）患者中，有 427 例患者接受了术前钆塞酸增强 MRI 检查。根据初始 TACE 的日期，患者被分为开发队列（n=211）和测试队列（n=216）。根据日本肝病学会指南确定 TACE 耐药性。进行单变量和多变量分析，以研究临床/MRI 特征与 TACE 耐药性之间的关系。使用判别能力的 C 指数和 Hosmer-Lemeshow 拟合优度检验对内、外部评估预测模型的性能。
通过对 427 例患者进行分析，我们构建了一个预测模型，其中包含与 TACE 耐药相关的以下独立特征：最大肿瘤大小；肿瘤数量；肝胆期（HBP）的肿瘤周围低信号；HBP 上存在非富血管性低信号结节。该系统能够预测开发队列（C 指数，0.796）和测试队列（C 指数，0.738）中的 TACE 耐药性，具有良好的判别能力和校准能力。
基于钆塞酸增强 MRI 特征的预测模型，除了包括肿瘤大小和数量在内的已知预测因素外，还可以用于估计中晚期 HCC 患者 TACE 耐药的风险。
