Clinical-Radiomic Analysis for Pretreatment Prediction of Objective Response to First Transarterial Chemoembolization in Hepatocellular Carcinoma

Abstract

<b><i>Background:</i></b> The preoperative selection of patients with intermediate-stage hepatocellular carcinoma (HCC) who are likely to have an objective response to first transarterial chemoembolization (TACE) remains challenging. <b><i>Objective:</i></b> To develop and validate a clinical-radiomic model (CR model) for preoperatively predicting treatment response to first TACE in patients with intermediate-stage HCC. <b><i>Methods:</i></b> A total of 595 patients with intermediate-stage HCC were included in this retrospective study. A tumoral and peritumoral (10 mm) radiomic signature (TPR-signature) was constructed based on 3,404 radiomic features from 4 regions of interest. A predictive CR model based on TPR-signature and clinical factors was developed using multivariate logistic regression. Calibration curves and area under the receiver operating characteristic curves (AUCs) were used to evaluate the model’s performance. <b><i>Results:</i></b> The final CR model consisted of 5 independent predictors, including TPR-signature (<i>p</i> < 0.001), AFP (<i>p</i> = 0.004), Barcelona Clinic Liver Cancer System Stage B (BCLC B) subclassification (<i>p</i> = 0.01), tumor location (<i>p</i> = 0.039), and arterial hyperenhancement (<i>p</i> = 0.050). The internal and external validation results demonstrated the high-performance level of this model, with internal and external AUCs of 0.94 and 0.90, respectively. In addition, the predicted objective response via the CR model was associated with improved survival in the external validation cohort (hazard ratio: 2.43; 95% confidence interval: 1.60–3.69; <i>p</i> < 0.001). The predicted treatment response also allowed for significant discrimination between the Kaplan-Meier curves of each BCLC B subclassification. <b><i>Conclusions:</i></b> The CR model had an excellent performance in predicting the first TACE response in patients with intermediate-stage HCC and could provide a robust predictive tool to assist with the selection of patients for TACE.

Hepatocellular carcinoma with extrahepatic blood supply from right renal artery

“…The prevalence of extrahepatic circulation in HCC is well-documented [ 1 ]. Initial studies on extrahepatic circulation in patients with HCC pointed towards the possibility of ligation of hepatic artery, a now obsolete treatment for HCC, as the causative factor [ 2 ].…”

Two-Trait Predictor of Venous Invasion on Contrast-Enhanced CT as a Preoperative Predictor of Outcomes for Early-Stage Hepatocellular Carcinoma After Hepatectomy

“…Notably, preoperative serum AFP may be an indirect indicator of tumor burden. In fact, several studies have reported that an elevated AFP serum level is one of the crucial factors heralding poor survival after surgical resection, radiofrequency ablation, and transcatheter arterial chemoembolization of HCC (31)(32)(33)(34).…”

A Comprehensive Review on Radiomics and Deep Learning for Nasopharyngeal Carcinoma Imaging

“…To date, radiomics has made impressive performances in tumour differentiation [ 43 , 44 , 45 ], prognosis evaluation [ 46 , 47 , 48 ], therapeutic effect evaluation [ 49 , 50 , 51 , 52 ], and tumour metastasis evaluation [ 53 , 54 , 55 ]. Compared with the performance of traditional predictive models based on clinical data and imaging anatomy, better performance of radiomics has been widely reported [ 24 , 56 , 57 ].…”