A preliminary study of developing an MRI-based model for postoperative recurrence prediction and treatment direction of intrahepatic cholangiocarcinoma.

IF 9.7 1区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Radiologia Medica Pub Date : 2024-11-02 DOI:10.1007/s11547-024-01910-y

Ruofan Sheng, Beixuan Zheng, Yunfei Zhang, Wei Sun, Chun Yang, Mengsu Zeng

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Abstract

Purpose: To establish an MRI-based predictive model for postoperative recurrence in intrahepatic cholangiocarcinoma (iCCA) and further to evaluate the model utility in treatment direction for neoadjuvant and adjuvant therapies.

Materials and methods: Totally 114 iCCA patients with curative surgery were retrospectively included, including 38 patients in the neoadjuvant treatment, traditional surgery, and adjuvant treatment groups for each. Predictive variables associated with postoperative recurrence were identified using univariate and multivariate Cox regression analyses, and a prognostic model was formulated. Recurrence-free survival (RFS) curves were compared using log-rank test between MRI-predicted high-risk and low-risk iCCAs stratified by the optimal threshold.

Results: Tumor multiplicity (hazard ratio (HR) = 1.671 [95%CI 1.036, 2.695], P = 0.035), hemorrhage (HR = 2.391 [95%CI 1.189, 4.810], P = 0.015), peri-tumor diffusion-weighted hyperintensity (HR = 1.723 [95%CI 1.085, 2.734], P = 0.021), and positive regional lymph node (HR = 2.175 [95%CI 1.295, 3.653], P = 0.003) were independently associated with postoperative recurrence; treatment group was not significantly related to recurrence (P > 0.05). Independent variables above were incorporated for the recurrence prediction model, the 1-year and 2-year time-dependent area under the curve values were 0.723 (95%CI 0.631, 0.815) and 0.725 (95%CI 0.634, 0.816), respectively. After risk stratification, the MRI-predicted high-risk iCCA patients had higher cumulative incidences of recurrence and worse RFS than the low-risk patients (P < 0.001 for both). In the MRI-predicted high-risk patients, neoadjuvant therapy was associated with improved all-stage RFS (P = 0.034), and adjuvant therapy was associated with improved RFS after 4 months (P = 0.014).

Conclusions: The MRI-based iCCA recurrence predictive model may serve as a decision-making tool for both personalized prognostication and therapy selection.

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建立基于磁共振成像的肝内胆管癌术后复发预测和治疗方向模型的初步研究。

目的：建立基于磁共振成像的肝内胆管癌（iCCA）术后复发预测模型，并进一步评估该模型在新辅助治疗和辅助治疗方向上的实用性：回顾性纳入114例接受根治性手术的iCCA患者，包括新辅助治疗组、传统手术组和辅助治疗组各38例。通过单变量和多变量 Cox 回归分析确定了与术后复发相关的预测变量，并建立了预后模型。使用对数秩检验比较了按最佳阈值分层的MRI预测的高风险和低风险iCCA的无复发生存率（RFS）曲线：肿瘤多发性（危险比 (HR) = 1.671 [95%CI 1.036, 2.695]，P = 0.035）、出血（HR = 2.391 [95%CI 1.189, 4.810]，P = 0.015）、肿瘤周围弥散加权高密度（HR = 1.723 [95%CI 1.085, 2.734]，P = 0.021）和区域淋巴结阳性（HR = 2.175 [95%CI 1.295, 3.653]，P = 0.003）与术后复发独立相关；治疗组与复发无显著相关性（P > 0.05）。将上述独立变量纳入复发预测模型后，1年和2年的时间依赖曲线下面积值分别为0.723（95%CI 0.631，0.815）和0.725（95%CI 0.634，0.816）。风险分层后，MRI 预测的高风险 iCCA 患者的累计复发率和 RFS 均高于低风险患者（P基于 MRI 的 iCCA 复发预测模型可作为个性化预后和治疗选择的决策工具。

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来源期刊

Radiologia Medica 医学-核医学

CiteScore

14.10

自引率

7.90%

发文量

133

审稿时长

4-8 weeks

期刊介绍： Felice Perussia founded La radiologia medica in 1914. It is a peer-reviewed journal and serves as the official journal of the Italian Society of Medical and Interventional Radiology (SIRM). The primary purpose of the journal is to disseminate information related to Radiology, especially advancements in diagnostic imaging and related disciplines. La radiologia medica welcomes original research on both fundamental and clinical aspects of modern radiology, with a particular focus on diagnostic and interventional imaging techniques. It also covers topics such as radiotherapy, nuclear medicine, radiobiology, health physics, and artificial intelligence in the context of clinical implications. The journal includes various types of contributions such as original articles, review articles, editorials, short reports, and letters to the editor. With an esteemed Editorial Board and a selection of insightful reports, the journal is an indispensable resource for radiologists and professionals in related fields. Ultimately, La radiologia medica aims to serve as a platform for international collaboration and knowledge sharing within the radiological community.