Decision-Tree Models Indicative of Microvascular Invasion on MRI Predict Survival in Patients with Hepatocellular Carcinoma Following Tumor Ablation

IF 4.2 3区 医学 Q2 ONCOLOGY Journal of Hepatocellular Carcinoma Pub Date : 2024-07-03 DOI:10.2147/jhc.s454487
Robin Schmidt, Charlie Alexander Hamm, Christopher Rueger, Han Xu, Yubei He, Luzie Alexandra Gottwald, Bernhard Gebauer, Lynn Jeanette Savic
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Abstract

Purpose: Histological microvascular invasion (MVI) is a risk factor for poor survival and early recurrence in hepatocellular carcinoma (HCC) after surgery. Its prognostic value in the setting of locoregional therapies (LRT), where no tissue samples are obtained, remains unknown. This study aims to establish CT-derived indices indicative of MVI on liver MRI with superior soft tissue contrast and evaluate their association with patient survival after ablation via interstitial brachytherapy (iBT) versus iBT combined with prior conventional transarterial chemoembolization (cTACE).
Patients and Methods: Ninety-five consecutive patients, who underwent ablation via iBT alone (n = 47) or combined with cTACE (n = 48), were retrospectively included between 01/2016 and 12/2017. All patients received contrast-enhanced MRI prior to LRT. Overall (OS), progression-free survival (PFS), and time-to-progression (TTP) were assessed. Decision-tree models to determine Radiogenomic Venous Invasion (RVI) and Two-Trait Predictor of Venous Invasion (TTPVI) on baseline MRI were established, validated on an external test set (TCGA-LIHC), and applied in the study cohorts to investigate their prognostic value for patient survival. Statistics included Fisher’s exact and t-test, Kaplan–Meier and cox-regression analysis, area under the receiver operating characteristic curve (AUC-ROC) and Pearson’s correlation.
Results: OS, PFS, and TTP were similar in both treatment groups. In the external dataset, RVI showed low sensitivity but relatively high specificity (AUC-ROC = 0.53), and TTPVI high sensitivity but only low specificity (AUC-ROC = 0.61) for histological MVI. In patients following iBT alone, positive RVI and TTPVI traits were associated with poorer OS (RVI: p < 0.01; TTPVI: p = 0.08), PFS (p = 0.04; p = 0.04), and TTP (p = 0.14; p = 0.03), respectively. However, when patients with combined cTACE and iBT were stratified by RVI or TTPVI, no differences in OS (p = 0.75; p = 0.55), PFS (p = 0.70; p = 0.43), or TTP (p = 0.33; p = 0.27) were observed.
Conclusion: The study underscores the role of non-invasive imaging biomarkers indicative of MVI to identify patients, who would potentially benefit from embolotherapy via cTACE prior to ablation rather than ablation alone.

Keywords: cancer imaging, hepatocellular carcinoma, microvascular invasion, magnetic resonance tomography, predictive imaging biomarkers
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核磁共振成像显示微血管侵犯的决策树模型预测肿瘤消融术后肝细胞癌患者的生存率
目的:组织学微血管侵犯(MVI)是肝细胞癌(HCC)术后生存率低和早期复发的风险因素。在不获取组织样本的局部区域疗法(LRT)中,MVI 的预后价值仍然未知。本研究旨在确定肝脏磁共振成像(MRI)上指示 MVI 的 CT 衍生指数,并评估这些指数与通过间质近距离放射治疗(iBT)消融与 iBT 联合先期传统经动脉化疗栓塞(cTACE)消融后患者存活率的关系:回顾性纳入2016年1月至2017年12月期间接受单独iBT消融术(47例)或联合cTACE消融术(48例)的95例连续患者。所有患者在 LRT 之前都接受了造影剂增强 MRI 检查。对总生存期(OS)、无进展生存期(PFS)和进展时间(TTP)进行了评估。建立了决策树模型来确定基线核磁共振成像上的放射基因组静脉侵犯(RVI)和静脉侵犯的双特征预测因子(TTPVI),并在外部测试集(TCGA-LIHC)上进行了验证,将其应用于研究队列,以研究其对患者生存的预后价值。统计数据包括费雪精确检验和t检验、Kaplan-Meier和cox-回归分析、接收者操作特征曲线下面积(AUC-ROC)和皮尔逊相关性:结果:两个治疗组的OS、PFS和TTP相似。在外部数据集中,RVI 对组织学 MVI 的敏感性较低,但特异性相对较高(AUC-ROC = 0.53);TTPVI 对组织学 MVI 的敏感性较高,但特异性较低(AUC-ROC = 0.61)。在单独进行 iBT 的患者中,RVI 和 TTPVI 阳性分别与较差的 OS(RVI:p < 0.01;TTPVI:p = 0.08)、PFS(p = 0.04;p = 0.04)和 TTP(p = 0.14;p = 0.03)相关。然而,当合并 cTACE 和 iBT 的患者按 RVI 或 TTPVI 分层时,观察到 OS(p = 0.75;p = 0.55)、PFS(p = 0.70;p = 0.43)或 TTP(p = 0.33;p = 0.27)无差异:该研究强调了指示微血管侵犯的非侵入性成像生物标志物在识别患者方面的作用,这些患者可能会在消融术前通过 cTACE 进行栓塞治疗,而不是仅进行消融术。 关键词:癌症成像;肝细胞癌;微血管侵犯;磁共振断层扫描;预测性成像生物标志物
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CiteScore
0.50
自引率
2.40%
发文量
108
审稿时长
16 weeks
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