Department of Radiology, the Second Affiliated Hospital of Harbin Medical University, Harbin 150086, China; Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China.
Department of Breast Surgery, Harbin Medical University Cancer Hospital, Harbin 150081, China.
Hepatobiliary Pancreat Dis Int. 2023 Dec;22(6):594-604. doi: 10.1016/j.hbpd.2022.11.005. Epub 2022 Nov 22.
Although transarterial chemoembolization (TACE) is the first-line therapy for intermediate-stage hepatocellular carcinoma (HCC), it is not suitable for all patients. This study aimed to determine how to select patients who are not suitable for TACE as the first treatment choice.
A total of 243 intermediate-stage HCC patients treated with TACE at three centers were retrospectively enrolled, of which 171 were used for model training and 72 for testing. Radiomics features were screened using the Spearman correlation analysis and the least absolute shrinkage and selection operator (LASSO) algorithm. Subsequently, a radiomics model was established using extreme gradient boosting (XGBoost) with 5-fold cross-validation. The Shapley additive explanations (SHAP) method was used to visualize the radiomics model. A clinical model was constructed using univariate and multivariate logistic regression. The combined model comprising the radiomics signature and clinical factors was then established. This model's performance was evaluated by discrimination, calibration, and clinical application. Generalization ability was evaluated by the testing cohort. Finally, the model was used to analyze overall and progression-free survival of different groups.
A third of the patients (81/243) were unsuitable for TACE treatment. The combined model had a high degree of accuracy as it identified TACE-unsuitable cases, at a sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) of 0.759, 0.885, 0.906 [95% confidence interval (CI): 0.859-0.953] in the training cohort and 0.826, 0.776, and 0.894 (95% CI: 0.815-0.972) in the testing cohort, respectively.
The high degree of accuracy of our clinical-radiomics model makes it clinically useful in identifying intermediate-stage HCC patients who are unsuitable for TACE treatment.
虽然经动脉化疗栓塞术（TACE）是治疗中期肝细胞癌（HCC）的一线治疗方法，但并不适合所有患者。本研究旨在确定如何选择不适合 TACE 作为首选治疗方法的患者。
回顾性纳入三家中心的 243 例接受 TACE 治疗的中期 HCC 患者，其中 171 例用于模型训练，72 例用于测试。采用 Spearman 相关分析和最小绝对收缩和选择算子（LASSO）算法筛选放射组学特征。然后，使用 5 折交叉验证的极端梯度提升（XGBoost）构建放射组学模型。使用 Shapley 加法解释（SHAP）方法可视化放射组学模型。采用单因素和多因素逻辑回归构建临床模型。然后建立包括放射组学特征和临床因素的联合模型。通过判别、校准和临床应用评估该模型的性能。通过测试队列评估其泛化能力。最后，该模型用于分析不同组别的总生存和无进展生存情况。
三分之一的患者（243 例中有 81 例）不适合 TACE 治疗。联合模型具有较高的准确性，能够识别 TACE 不适用病例，在训练队列中的敏感性、特异性和受试者工作特征曲线（ROC）下面积（AUC）分别为 0.759、0.885 和 0.906[95%置信区间（CI）：0.859-0.953]，在测试队列中的敏感性、特异性和 AUC 分别为 0.826、0.776 和 0.894（95%CI：0.815-0.972）。
我们的临床放射组学模型具有较高的准确性，在识别不适合 TACE 治疗的中期 HCC 患者方面具有临床应用价值。
