Background: Whether peritumoral dilation radiomics can excellently predict early recrudescence (≤ 2 years) in hepatocellular carcinoma (HCC) remains unclear.
Methods: Between March 2012 and June 2018, 323 pathologically confirmed HCC patients without macrovascular invasion, who underwent liver resection and preoperative gadoxetate disodium (Gd-EOB-DTPA) MRI, were consecutively recruited into this study. Multivariate logistic regression identified independent clinicoradiologic predictors of 2-year recrudescence. Peritumoral dilation (tumor and peritumoral zones within 1cm) radiomics extracted features from 7-sequence images for modeling and achieved average but robust predictive performance through 5-fold cross validation. Independent clinicoradiologic predictors were then incorporated with the radiomics model for constructing a comprehensive nomogram. The predictive discrimination was quantified with the area under the receiver operating characteristic curve (AUC) and net reclassification improvement (NRI).
Results: With the median recurrence-free survival (RFS) reaching 60.43 months, 28.2% (91/323) and 16.4% (53/323) patients suffered from early and delay relapse, respectively. Microvascular invasion, tumor size > 5 cm, alanine aminotransferase > 50 U/L, γ-glutamyltransferase > 60 U/L, prealbumin ≤ 250 mg/L, and peritumoral enhancement independently impaired 2-year RFS in the clinicoradiologic model with AUC of 0.694 (95% CI 0.628– 0.760). Nevertheless, these indexes were paucity of robustness (P > 0.05) when integrating with 38 most recurrence-related radiomics signatures for developing the comprehensive nomogram. The peritumoral dilation radiomics—the ultimate prediction model yielded satisfactory mean AUCs (training cohort: 0.939, 95% CI 0.908– 0.973; validation cohort: 0.842, 95% CI 0.736– 0.951) after 5-fold cross validation and fitted well with the actual relapse status in the calibration curve. Besides, our radiomics model obtained the best clinical net benefits, with significant improvements of NRI (35.9%-66.1%, P < 0.001) versus five clinical algorithms: the clinicoradiologic model, the tumor-node-metastasis classification, the Barcelona Clinic Liver Cancer stage, the preoperative and postoperative risks of Early Recurrence After Surgery for Liver tumor.
Conclusion: Gd-EOB-DTPA MRI-based peritumoral dilation radiomics is a potential preoperative biomarker for early recurrence of HCC patients without macrovascular invasion.



中文翻译：

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钆塞酸二钠增强 MRI 的瘤周扩张影像组学很好地预测肝切除术后无大血管浸润的肝细胞癌的早期复发

背景：肿瘤周围扩张放射组学能否很好地预测肝细胞癌 (HCC) 的早期复发（≤ 2 年）仍不清楚。
方法：2012 年 3 月至 2018 年 6 月，连续招募 323 例经病理证实的无大血管侵犯的 HCC 患者，他们接受了肝切除术和术前钆塞酸二钠 (Gd-EOB-DTPA) MRI 检查。多变量逻辑回归确定了 2 年复发的独立临床放射学预测因子。瘤周扩张（1cm 内的肿瘤和瘤周区域）放射组学从 7 序列图像中提取特征进行建模，并通过 5 倍交叉验证实现了平均但稳健的预测性能。然后将独立的临床放射学预测因子与放射组学模型结合以构建综合列线图。预测歧视用接受者操作特征曲线下的面积（AUC）和净重分类改善（NRI）来量化。
结果：中位无复发生存期 (RFS) 达到 60.43 个月，分别有 28.2% (91/323) 和 16.4% (53/323) 的患者出现早期复发和延迟复发。在临床放射学模型中，微血管侵犯、肿瘤大小 > 5 cm、丙氨酸氨基转移酶 > 50 U/L、γ-谷氨酰转移酶 > 60 U/L、前白蛋白 ≤ 250 mg/L 和瘤周增强独立损害了临床放射学模型中的 2 年 RFS，AUC 为 0.694 (95% CI 0.628–0.760)。然而，当与 38 个最与复发相关的放射组学特征整合以开发综合列线图时，这些指标缺乏稳健性 (P > 0.05)。肿瘤周围扩张放射组学——最终预测模型产生了令人满意的平均 AUC（训练队列：0.939，95% CI 0.908–0.973；验证队列：0.842，95% CI 0.736–0。951）经过 5 折交叉验证，与校准曲线中的实际复发状态吻合良好。此外，我们的放射组学模型获得了最佳的临床净收益，与五种临床算法相比，NRI 有显着改善（35.9%-66.1%，P < 0.001）：临床放射学模型、肿瘤-淋巴结-转移分类、巴塞罗那临床肝癌分期，肝肿瘤术后早期复发的术前和术后风险。
结论：基于 Gd-EOB-DTPA MRI 的瘤周扩张放射组学是一种潜在的术前生物标志物，可用于无大血管侵犯的 HCC 患者早期复发。