Prognostic Value of Computed Tomography Texture Features in Patients with Hepatocellular Carcinoma Following Stereotactic Ablative Radiotherapy

Background: Hepatocellular carcinoma (HCC) is the sixth most common cancer worldwide. Cases of HCC in Africa and East Asia account for 80% of all HCC cases around the world. China is one of the countries with a high incidence rate of HCC. Objectives: This case-control study aimed to explore the prognostic value of computed tomography (CT) texture features in patients with HCC following stereotactic ablative radiotherapy (SABR). Patients and Methods: A total of 100 HCC patients, treated with SABR from January 2019 to January 2021, were divided into good prognosis (n = 57) and poor prognosis (n = 43) groups. The patients’ general data and CT texture features were then compared. Factors associated with a poor prognosis were investigated in a multivariate logistic regression analysis. A clinical feature model, a CT texture feature model, and a joint model of clinical features and CT texture features were established, and their prognostic values were evaluated by plotting the receiver operating characteristic (ROC) curves. Moreover, a nomogram prediction model was developed according to the multivariate analysis results, and its prediction efficiency was assessed. Results: Age ≤ 40 years, serum alpha-fetoprotein level > 9 ng/mL, gamma-glutamyl transpeptidase > 60 U/L, aspartate aminotransferase > 40 U/L, lesion size > 5 cm, unsmooth tumor margins, no tumor capsule or incomplete capsule, multiple tumors, portal phase CT value of cancer > 135%, and a relative washout ratio > -24% in the portal phase of cancer were risk factors for a poor prognosis in HCC patients after SABR. The area under the ROC curve and sensitivity and specificity of the joint model were 0.817 (95% confidence interval [CI]: 0.773 - 0.861, P < 0.001), 80.47%, and 91.05%, respectively, which significantly exceeded those of the other two models. The nomogram prediction model showed high accuracy and validity. Conclusion: The texture features of CT images before SABR are of a high prognostic value for HCC patients and contribute to the selection of appropriate treatment protocols.