Ma Lidi, Zhang Cheng, Wen Yuhua, Xing Kaili, Li Shaohua, Geng Zhijun, Liao Shuting, Yuan Shasha, Li Xinming, Zhong Chong, Hou Jing, Zhang Jie, Gao Mingyong, Xu Baojun, Guo Rongping, Wei Wei, Xie Chuanmiao, Lu Lianghe
Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-Sen University Cancer Center.
Department of Radiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China.
Int J Surg. 2025 Jan 1;111(1):872-883. doi: 10.1097/JS9.0000000000001903.
Patients with microvascular invasion (MVI)-positive hepatocellular carcinoma (HCC) have shown promising results with adjuvant hepatic arterial infusion chemotherapy (HAIC) with FOLFOX after curative resection. The authors aim to develop an imaging-derived biomarker to depict MVI-positive HCC patients more precisely and promote individualized treatment strategies of adjuvant HAIC.
Patients with MVI-positive HCC were identified from five academic centers and utilized for model development ( n =470). Validation cohorts were pooled from a previously reported prospective clinical study conducted [control cohort ( n =145), adjuvant HAIC cohort ( n =143)] (NCT03192618). The primary endpoint was recurrence-free survival (RFS). Imaging features were thoroughly reviewed, and multivariable logistic regression analysis was employed for model development. Transcriptomic sequencing was conducted to identify the associated biological processes.
Arterial phase peritumoral enhancement, boundary of the tumor enhancement, tumor necrosis stratification, and boundary of the necrotic area were selected and incorporated into the nomogram for RFS. The imaging-based model successfully stratified patients into two distinct prognostic subgroups in both the training, control, and adjuvant HAIC cohorts (median RFS, 6.00 vs. 66.00 months, 4.86 vs. 24.30 months, 11.46 vs. 39.40 months, all P <0.01). Furthermore, no significant statistical difference was observed between patients at high risk of adjuvant HAIC and those in the control group ( P =0.61). The area under the receiver operating characteristic curve at 2 years was found to be 0.83, 0.84, and 0.73 for the training, control, and adjuvant HAIC cohorts, respectively. Transcriptomic sequencing analyses revealed associations between the radiological features and immune-regulating signal transduction pathways.
The utilization of this imaging-based model could help to better characterize MVI-positive HCC patients and facilitate the precise subtyping of patients who genuinely benefit from adjuvant HAIC treatment.
微血管侵犯（MVI）阳性的肝细胞癌（HCC）患者在根治性切除术后接受含奥沙利铂的氟尿嘧啶、亚叶酸钙和奥沙利铂（FOLFOX）辅助肝动脉灌注化疗（HAIC）已显示出有前景的结果。作者旨在开发一种基于影像的生物标志物，以更精确地描绘MVI阳性的HCC患者，并推动辅助HAIC的个体化治疗策略。
从五个学术中心确定MVI阳性的HCC患者并用于模型开发（n = 470）。验证队列来自先前报道的一项前瞻性临床研究[对照组（n = 145），辅助HAIC组（n = 143）]（NCT03192618）。主要终点是无复发生存期（RFS）。对影像特征进行全面回顾，并采用多变量逻辑回归分析进行模型开发。进行转录组测序以确定相关的生物学过程。
动脉期瘤周强化、肿瘤强化边界、肿瘤坏死分层和坏死区域边界被选择并纳入RFS列线图。基于影像的模型在训练组、对照组和辅助HAIC组中均成功地将患者分为两个不同的预后亚组（中位RFS，6.00对66.00个月、4.86对24.30个月、11.46对39.40个月，均P<0.01）。此外，辅助HAIC高风险患者与对照组患者之间未观察到显著统计学差异（P = 0.61）。训练组、对照组和辅助HAIC组在2年时的受试者工作特征曲线下面积分别为0.83、0.84和0.73。转录组测序分析揭示了放射学特征与免疫调节信号转导通路之间的关联。
使用这种基于影像的模型有助于更好地表征MVI阳性的HCC患者，并促进真正从辅助HAIC治疗中获益的患者的精确分型。
