Department of Radiology, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, 310022, Zhejiang, China.
Postgraduate Training Base Alliance of Wenzhou Medical University, Wenzhou, 325035, China.
Abdom Radiol (NY). 2024 Jul;49(7):2387-2400. doi: 10.1007/s00261-024-04319-3. Epub 2024 Jul 19.
We developed and validated a clinical-radiomics model for preoperative prediction of the short-term efficacy of initial drug-eluting beads transarterial chemoembolization (D-TACE) treatment in patients with hepatocellular carcinoma (HCC).
In this retrospective cohort study of 113 patients with intermediate and advanced HCC, 5343 features were extracted based on three sequences of the arterial phase (AP), diffusion-weighted imaging, and T2-weighted images based on contrast-enhanced magnetic resonance imaging, and minimum redundancy maximum correlation and least absolute shrinkage and selection operator (LASSO) regression were applied for feature selection and model construction. Multifactor logistic regression was used to build a clinical-imaging model based on clinical factors and a clinical-radiomics model. The area under the curve (AUC) and calibration curves were used to assess model performance, and the clinical value of the model was analyzed using decision curve analysis. The relationship between the actual and predicted short-term efficacy of the combined model and progression-free survival (PFS) was evaluated using Kaplan-Meier survival curves and log-rank tests.
A total of 34 radiomics features were selected by LASSO, and the clinical-radiomics model had the best predictive performance (AUC = 0.902 and AUC = 0.845 for the training and testing sets, respectively), and the model based on AP had the best predictive performance among the four radiomics models (AUC = 0.89 for the training set and AUC = 0.85 for the testing set); the multifactorial logistic regression results showed that microsphere type (p = 0.042) and AP Rad-score (p = 0.01) were associated with short-term efficacy. In addition, a difference in PFS was observed in patients with HCC with different short-term efficacies predicted by the combined model. Moreover, prognosis was better in the objective versus non-objective response group.
The combined clinical-radiomics model is an effective predictor of the short-term efficacy of initial D-TACE in patients with HCC, contributing to clinical and economic benefits for patients.
我们开发并验证了一种临床放射组学模型，用于预测肝细胞癌（HCC）患者初始载药微球动脉化疗栓塞术（D-TACE）治疗短期疗效。
本回顾性队列研究纳入了 113 例中晚期 HCC 患者，基于对比增强磁共振成像的动脉期（AP）、弥散加权成像和 T2 加权图像提取了 5343 个特征，并采用最小冗余最大相关性和最小绝对值收缩和选择算子（LASSO）回归进行特征选择和模型构建。多因素逻辑回归用于构建基于临床因素的临床影像模型和临床放射组学模型。采用曲线下面积（AUC）和校准曲线评估模型性能，并通过决策曲线分析分析模型的临床价值。采用 Kaplan-Meier 生存曲线和对数秩检验评估联合模型的实际和预测短期疗效与无进展生存期（PFS）的关系。
LASSO 筛选出 34 个放射组学特征，临床放射组学模型具有最佳预测性能（训练集和验证集的 AUC 分别为 0.902 和 0.845），AP 放射组学模型在 4 个放射组学模型中具有最佳预测性能（训练集 AUC 为 0.89，验证集 AUC 为 0.85）；多因素逻辑回归结果显示，微球类型（p=0.042）和 AP Rad-score（p=0.01）与短期疗效相关。此外，联合模型预测的短期疗效不同的 HCC 患者的 PFS 存在差异，而且客观反应组的预后更好。
联合临床放射组学模型是预测 HCC 患者初始 D-TACE 短期疗效的有效指标，有助于为患者带来临床和经济效益。
