Multimodal imaging-based prediction of recurrence for unresectable HCC after downstage and resection-cohort study

作者：Hanyu Jiang, Mengxuan Zuo, Wang Li, Shuiqing Zhuo, Peihong Wu, Chao An · 发表于：International Journal of Surgery · 年份：2024 · DOI：10.1097/js9.0000000000001752 · 被引用次数：15 · 研究领域：Hepatocellular Carcinoma Treatment and Prognosis、Radiomics and Machine Learning in Medical Imaging、MRI in cancer diagnosis

BACKGROUND: Surgical resection (SR) following transarterial chemoembolization (TACE)-based downstaging is a promising treatment for unresectable hepatocellular carcinoma (uHCC), and identification of patients at high-risk of postoperative recurrence may assist individualized treatment. PURPOSE: To develop and externally validate preoperative and postoperative prognostic models integrating multimodal CT and digital subtraction angiography features as well as clinico-therapeutic-pathological features for predicting disease-free survival (DFS) after TACE-based downstaging therapy. MATERIALS AND METHODS: From March 2008 to August 2022, 488 consecutive patients with Barcelona Clinic Liver Cancer (BCLC) A/B uHCC receiving TACE-based downstaging therapy and subsequent SR were included from four tertiary-care hospitals. All CT and digital subtraction angiography images were independently evaluated by two blinded radiologists. In the derivation cohort ( n =390), the XGBoost algorithm was used for feature selection, and Cox regression analysis for developing nomograms for DFS (time from downstaging to postoperative recurrence or death). In the external testing cohort ( n =98), model performances were compared with five major staging systems. RESULTS: The preoperative nomogram included over three tumors [hazard ratio (HR), 1.42; P =0.003], intratumoral artery (HR, 1.38; P =0.006), TACE combined with tyrosine kinase inhibitor (HR, 0.46; P <0.001) and objective response to downstaging the...