Zhang Nan, Yang Yue, Lin Ke, Qiao Bin, Yang Dao-Peng, Jin Dong-Dong, Li Bin, Zhao Dong-Liang, Xie Xiao-Hua, Xie Xiao-Yan, Kang Ji-Hui, Zhuang Bo-Wen
Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, NO.58 Zhongshan Road 2, Guangzhou, 510080, China.
Clinical Research Unit, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
Cancer Imaging. 2025 Aug 27;25(1):107. doi: 10.1186/s40644-025-00923-8.
Pathologically, intrahepatic cholangiocarcinoma (ICC) is classified into small-duct (SD) type and large-duct (LD) type, each with distinct clinicopathological characteristics. The contrast-enhanced ultrasound (CEUS) features of the two ICC types remain insufficiently explored.
To evaluate liver CEUS imaging for differentiating the SD and LD types of ICC and further compare them with poorly differentiated hepatocellular carcinoma (pHCC).
A single-center retrospective study enrolled 252 patients with SD-type ICC, LD-type ICC, or pHCC between October 2017 and August 2023. Logistic regression analyses identified independent clinical, pathological, ultrasound, and CEUS predictors. Based on these features, a decision tree-based diagnostic model was developed. The model's performance was evaluated using receiver operating characteristic (ROC) curve analysis in both the training and validation cohorts, as well as in subgroup stratified by tumor size ≤ 5 cm and > 5 cm. Differences in overall survival (OS) and recurrence-free survival (RFS) based on the model were further analyzed.
Overall, 252 patients (mean age, 58.4 ± 10.7 years; 174 males) with 140 SD-type ICC, 55 LD-type ICC and 57 pHCC were enrolled. Multivariate analysis revealed that AFP, CEA, CA19-9, HBsAg status, arterial phase enhancement pattern, washout time ≤ 45 s, and marked washout were independent predictors for tumor categories differentiation (all P <.05). The decision tree-based model incorporating the major features demonstrated excellent performance in both the training cohort (AUC 0.89) and validation cohort (AUC 0.88), as well as in tumor size ≤ 5 cm (AUC 0.90) and > 5 cm (AUC 0.84). OS was significantly worse in LD-type ICC patients compared to SD-type and pHCC (P <.05 for both), while RFS showed no significant difference.
A user-friendly, decision tree-based diagnostic model was developed to accurately predict ICC subtypes and pHCC, facilitating improved clinical decision-making. The decision tree-based diagnostic model effectively diagnosed small-duct type and large-duct type intrahepatic cholangiocarcinoma, as well as poorly differentiated hepatocellular carcinoma.
在病理学上，肝内胆管癌（ICC）分为小胆管（SD）型和大胆管（LD）型，每种类型都有独特的临床病理特征。两种ICC类型的超声造影（CEUS）特征仍未得到充分研究。
评估肝脏CEUS成像以区分ICC的SD型和LD型，并进一步将它们与低分化肝细胞癌（pHCC）进行比较。
一项单中心回顾性研究纳入了2017年10月至2023年8月期间的252例SD型ICC、LD型ICC或pHCC患者。逻辑回归分析确定了独立的临床、病理、超声和CEUS预测因素。基于这些特征，开发了一种基于决策树的诊断模型。在训练队列和验证队列中，以及在按肿瘤大小≤5 cm和>5 cm分层的亚组中，使用受试者操作特征（ROC）曲线分析评估该模型的性能。进一步分析基于该模型的总生存期（OS）和无复发生存期（RFS）的差异。
总体而言，共纳入252例患者（平均年龄58.4±10.7岁；男性174例），其中SD型ICC 140例，LD型ICC 55例，pHCC 57例。多因素分析显示，甲胎蛋白（AFP）、癌胚抗原（CEA）、糖类抗原19-9（CA19-9）、乙肝表面抗原（HBsAg）状态、动脉期强化模式、廓清时间≤45秒和明显廓清是肿瘤类别区分的独立预测因素（均P<0.05）。纳入主要特征的基于决策树的模型在训练队列（AUC 0.89）和验证队列（AUC 0.88）中，以及在肿瘤大小≤5 cm（AUC 0.90）和>5 cm（AUC 0.84）的亚组中均表现出优异的性能。与SD型和pHCC相比，LD型ICC患者的OS明显更差（两者均P<0.05），而RFS无显著差异。
开发了一种用户友好的基于决策树的诊断模型，以准确预测ICC亚型和pHCC，有助于改善临床决策。基于决策树的诊断模型有效地诊断了小胆管型和大胆管型肝内胆管癌以及低分化肝细胞癌。
