He Mu, Zhang Peng, Ma Xiao, He Baochun, Fang Chihua, Jia Fucang
The First Department of Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University, Guangdong Provincial Clinical and Engineering Center of Digital Medicine, Guangzhou, China.
Research Laboratory for Medical Imaging and Digital Surgery, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China.
Front Oncol. 2020 Nov 5;10:574228. doi: 10.3389/fonc.2020.574228. eCollection 2020.
OBJECTIVE: This study aimed to build and evaluate a radiomics feature-based model for the preoperative prediction of microvascular invasion (MVI) in patients with hepatocellular carcinoma. METHODS: A total of 145 patients were retrospectively included in the study pool, and the patients were divided randomly into two independent cohorts with a ratio of 7:3 (training cohort: n = 101, validation cohort: n = 44). For a pilot study of this predictive model another 18 patients were recruited into this study. A total of 1,231 computed tomography (CT) image features of the liver parenchyma without tumors were extracted from portal-phase CT images. A least absolute shrinkage and selection operator (LASSO) logistic regression was applied to build a radiomics score (Rad-score) model. Afterwards, a nomogram, including Rad-score as well as other clinicopathological risk factors, was established with a multivariate logistic regression model. The discrimination efficacy, calibration efficacy, and clinical utility value of the nomogram were evaluated. RESULTS: The Rad-score scoring model could predict MVI with the area under the curve (AUC) of 0.637 (95% CI, 0.516-0.758) in the training cohort as well as of 0.583 (95% CI, 0.395-0.770) in the validation cohort; however, the aforementioned discriminative approach could not completely outperform those existing predictors (alpha fetoprotein, neutrophilic granulocyte, and preoperative hemoglobin). The individual predictive nomogram which included the Rad-score, alpha fetoprotein, neutrophilic granulocyte, and preoperative hemoglobin showed a better discrimination efficacy with AUC of 0.865 (95% CI, 0.786-0.944), which was higher than the conventional methods' AUCs (nomogram vs Rad-score, alpha fetoprotein, neutrophilic granulocyte, and preoperative hemoglobin at P < 0.001, P = 0.025, P < 0.001, and P = 0.001, respectively). When applied to the validation cohort, the nomogram discrimination efficacy was still outbalanced those above mentioned three remaining methods (AUC: 0.705; 95% CI, 0.537-0.874). The calibration curves of this proposed method showed a satisfying consistency in both cohorts. A prospective pilot analysis showed that the nomogram could predict MVI with an AUC of 0.844 (95% CI, 0.628-1.000). CONCLUSIONS: The radiomics feature-based predictive model improved the preoperative prediction of MVI in HCC patients significantly. It could be a potentially valuable clinical utility.
目的:本研究旨在构建并评估一种基于放射组学特征的模型,用于术前预测肝细胞癌患者的微血管侵犯(MVI)。 方法:本研究共回顾性纳入145例患者,并将其随机分为两个独立队列,比例为7:3(训练队列:n = 101,验证队列:n = 44)。为对该预测模型进行初步研究,另外招募了18例患者纳入本研究。从门静脉期CT图像中提取了1231个无肿瘤肝实质的计算机断层扫描(CT)图像特征。应用最小绝对收缩和选择算子(LASSO)逻辑回归构建放射组学评分(Rad-score)模型。之后,使用多变量逻辑回归模型建立了一个列线图,其中包括Rad-score以及其他临床病理危险因素。评估了列线图的判别效能、校准效能和临床实用价值。 结果:Rad-score评分模型在训练队列中预测MVI的曲线下面积(AUC)为0.637(95%CI,0.516 - 0.758),在验证队列中为0.583(95%CI,0.395 - 0.770);然而,上述判别方法并不能完全优于现有的预测指标(甲胎蛋白、中性粒细胞和术前血红蛋白)。包含Rad-score、甲胎蛋白、中性粒细胞和术前血红蛋白的个体预测列线图显示出更好的判别效能,AUC为0.865(95%CI,0.786 - 0.944),高于传统方法的AUC(列线图与Rad-score、甲胎蛋白、中性粒细胞和术前血红蛋白相比,P分别<0.001、0.025、<0.001和0.001)。当应用于验证队列时,列线图的判别效能仍然优于上述其余三种方法(AUC:0.705;95%CI,0.537 - 0.874)。该方法的校准曲线在两个队列中均显示出令人满意的一致性。一项前瞻性初步分析表明,列线图预测MVI的AUC为0.844(95%CI,0.628 - 1.000)。 结论:基于放射组学特征的预测模型显著改善了肝细胞癌患者术前对MVI的预测。它可能具有潜在的有价值的临床实用性。
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