Comprehensive radiomics nomogram for predicting survival of patients with combined hepatocellular carcinoma and cholangiocarcinoma.
Comprehensive radiomics nomogram for predicting survival of patients with combined hepatocellular carcinoma and cholangiocarcinoma.
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DOI：
10.3748/wjg.v27.i41.7173
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发表时间：
2021-11-07
影响因子：
4.3
通讯作者：
Ma XL
中科院分区：
文献类型：
--
作者：
Tang YY;Zhao YN;Zhang T;Chen ZY;Ma XL
肝细胞癌合并胆管细胞癌是指分化为肝细胞癌和肝内胆管细胞癌的单个结节，预后较差。[目的]建立预测CHCC-CCA患者术后生存的放射组学诺模图。将经病理诊断为CHCC-CCA的患者随机分为训练组和验证组。使用最小绝对收缩和选择算子COX回归和随机森林分析从门静脉期CT图像中提取放射组学特征。通过单因素分析和多因素COX回归分析，建立了放射组学评分与临床因素的关系图。通过C指数以及校准、判定和生存曲线来评估诺模图的性能。研究对象包括118例患者的CT和临床资料。放射组学评分、血管侵犯、解剖切除、总胆红素水平和卫星病变被发现是总存活率(OS)的独立预测因素，因此被包括在综合诺模图中。与基于放射组学评分或仅基于临床因素的模型相比，诺模图与OS的相关性更强(风险比：8.155，95%可信区间：4.498-14.785，P<；0.001)。在训练集中，1年和3年OS的曲线下面积分别为0.878和0.875。被分层为预后不良的高危患者的中位OS显著短于被分层为低风险的患者(6.1vs81.6mo，P<；0.001)。此图可预测肝切除术后CHCC-CCA患者的存活率，因此有助于识别更有可能从手术中受益的患者。
Combined hepatocellular carcinoma (HCC) and cholangiocarcinoma (cHCC-CCA) is defined as a single nodule showing differentiation into HCC and intrahepatic cholangiocarcinoma and has a poor prognosis. To develop a radiomics nomogram for predicting post-resection survival of patients with cHCC-CCA. Patients with pathologically diagnosed cHCC-CCA were randomly divided into training and validation sets. Radiomics features were extracted from portal venous phase computed tomography (CT) images using the least absolute shrinkage and selection operator Cox regression and random forest analysis. A nomogram integrating the radiomics score and clinical factors was developed using univariate analysis and multivariate Cox regression. Nomogram performance was assessed in terms of the C-index as well as calibration, decision, and survival curves. CT and clinical data of 118 patients were included in the study. The radiomics score, vascular invasion, anatomical resection, total bilirubin level, and satellite lesions were found to be independent predictors of overall survival (OS) and were therefore included in an integrative nomogram. The nomogram was more strongly associated with OS (hazard ratio: 8.155, 95% confidence interval: 4.498-14.785, P < 0.001) than a model based on the radiomics score or only clinical factors. The area under the curve values for 1-year and 3-year OS in the training set were 0.878 and 0.875, respectively. Patients stratified as being at high risk of poor prognosis showed a significantly shorter median OS than those stratified as being at low risk (6.1 vs 81.6 mo, P < 0.001). This nomogram may predict survival of cHCC-CCA patients after hepatectomy and therefore help identify those more likely to benefit from surgery.
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