Liu Ziwei, Yang Shaomin, Chen Xinjie, Luo Chun, Feng Jieying, Chen Haixiong, Ouyang Fusheng, Zhang Rong, Li Xiaohong, Liu Wei, Guo Baoliang, Hu Qiugen
Department of Radiology, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde), Foshan, China.
Department of Radiology, The Affiliated Shunde Hospital of Guangzhou Medical University, Foshan, China.
Front Oncol. 2022 Oct 14;12:954445. doi: 10.3389/fonc.2022.954445. eCollection 2022.
As an important biomarker to reflect tumor cell proliferation and tumor aggressiveness, Ki-67 is closely related to the high early recurrence rate and poor prognosis, and pretreatment evaluation of Ki-67 expression possibly provides a more accurate prognosis assessment and more better treatment plan. We aimed to develop a nomogram based on gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) combined with T1 mapping to predict Ki-67 expression in hepatocellular carcinoma (HCC).
This two-center study retrospectively enrolled 148 consecutive patients who underwent preoperative Gd-EOB-DTPA-enhanced MRI T1 mapping and surgically confirmed HCC from July 2019 to December 2020. The correlation between quantitative parameters from T1 mapping, ADC, and Ki-67 was explored. Three cohorts were constructed: a training cohort (n = 73) and an internal validation cohort (n = 31) from Shunde Hospital of Southern Medical University, and an external validation cohort (n = 44) from the Sixth Affiliated Hospital, South China University of Technology. The clinical variables and MRI qualitative and quantitative parameters associational with Ki-67 expression were analyzed by univariate and multivariate logistic regression analyses. A nomogram was developed based on these associated with Ki-67 expression in the training cohort and validated in the internal and external validation cohorts.
T1rt-Pre and T1rt-20min were strongly positively correlated with Ki-67 (r = 0.627, r = 0.607, < 0.001); the apparent diffusion coefficient value was moderately negatively correlated with Ki-67 (r = -0.401, < 0.001). Predictors of Ki-67 expression included in the nomogram were peritumoral enhancement, peritumoral hypointensity, T1rt-20min, and tumor margin, while arterial phase hyperenhancement (APHE) was not a significant predictor even included in the regression model. The nomograms achieved good concordance indices in predicting Ki-67 expression in the training and two validation cohorts (0.919, 0.925, 0.850), respectively.
T1rt-Pre and T1rt-20min had a strong positive correlation with the Ki-67 expression in HCC, and Gd-EOB-DTPA enhanced MRI combined with T1 mapping-based nomogram effectively predicts high Ki-67 expression in HCC.
作为反映肿瘤细胞增殖和肿瘤侵袭性的重要生物标志物，Ki-67与早期高复发率和不良预后密切相关，术前评估Ki-67表达可能提供更准确的预后评估和更好的治疗方案。我们旨在开发一种基于钆塞酸二钠（Gd-EOB-DTPA）增强磁共振成像（MRI）联合T1mapping的列线图，以预测肝细胞癌（HCC）中的Ki-67表达。
这项双中心研究回顾性纳入了2019年7月至2020年12月期间连续148例行术前Gd-EOB-DTPA增强MRI T1mapping且经手术证实为HCC的患者。探讨了T1mapping的定量参数、表观扩散系数（ADC）与Ki-67之间的相关性。构建了三个队列：南方医科大学顺德医院的训练队列（n = 73）和内部验证队列（n = 31），以及华南理工大学附属第六医院的外部验证队列（n = 44）。通过单因素和多因素逻辑回归分析，分析了与Ki-67表达相关的临床变量以及MRI定性和定量参数。基于训练队列中与Ki-67表达相关的因素开发了列线图，并在内部和外部验证队列中进行验证。
T1rt-Pre和T1rt-20min与Ki-67呈强正相关（r = 0.627，r = 0.607，P < 0.001）；表观扩散系数值与Ki-67呈中度负相关（r = -0.401，P < 0.001）。列线图中纳入的Ki-67表达预测因素包括瘤周强化、瘤周低信号、T1rt-20min和肿瘤边界，而动脉期高增强（APHE）即使纳入回归模型也不是显著预测因素。列线图在训练队列和两个验证队列中预测Ki-67表达时分别获得了良好的一致性指数（0.919、0.925、0.850）。
T1rt-Pre和T1rt-20min与HCC中Ki-67表达呈强正相关，Gd-EOB-DTPA增强MRI联合基于T1mapping的列线图可有效预测HCC中高Ki-67表达。
