Journal of Hepatocellular Carcinoma (Jun 2021)
Peritumoral Dilation Radiomics of Gadoxetate Disodium-Enhanced MRI Excellently Predicts Early Recurrence of Hepatocellular Carcinoma without Macrovascular Invasion After Hepatectomy
Abstract
Huanhuan Chong,1,2 Yuda Gong,3 Xianpan Pan,4 Aie Liu,4 Lei Chen,4 Chun Yang,1 Mengsu Zeng1,2,5 1Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, People’s Republic of China; 2Shanghai Institute of Medical Imaging, Shanghai, 200032, People’s Republic of China; 3Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, People’s Republic of China; 4Shanghai United Imaging Intelligence Co., Ltd, Shanghai, 200232, People’s Republic of China; 5Department of Medical Imaging, Shanghai Medical College, Fudan University, Shanghai, 200032, People’s Republic of ChinaCorrespondence: Mengsu Zeng; Chun YangDepartment of Radiology, Zhongshan Hospital, Fudan University, 180 Feng Lin Road, Shanghai, 200032, People’s Republic of ChinaTel +86-21-13501922963; +86-21-18702135336Email [email protected]; [email protected]: Whether peritumoral dilation radiomics can excellently predict early recrudescence (≤ 2 years) in hepatocellular carcinoma (HCC) remains unclear.Methods: Between March 2012 and June 2018, 323 pathologically confirmed HCC patients without macrovascular invasion, who underwent liver resection and preoperative gadoxetate disodium (Gd-EOB-DTPA) MRI, were consecutively recruited into this study. Multivariate logistic regression identified independent clinicoradiologic predictors of 2-year recrudescence. Peritumoral dilation (tumor and peritumoral zones within 1cm) radiomics extracted features from 7-sequence images for modeling and achieved average but robust predictive performance through 5-fold cross validation. Independent clinicoradiologic predictors were then incorporated with the radiomics model for constructing a comprehensive nomogram. The predictive discrimination was quantified with the area under the receiver operating characteristic curve (AUC) and net reclassification improvement (NRI).Results: With the median recurrence-free survival (RFS) reaching 60.43 months, 28.2% (91/323) and 16.4% (53/323) patients suffered from early and delay relapse, respectively. Microvascular invasion, tumor size > 5 cm, alanine aminotransferase > 50 U/L, γ-glutamyltransferase > 60 U/L, prealbumin ≤ 250 mg/L, and peritumoral enhancement independently impaired 2-year RFS in the clinicoradiologic model with AUC of 0.694 (95% CI 0.628– 0.760). Nevertheless, these indexes were paucity of robustness (P > 0.05) when integrating with 38 most recurrence-related radiomics signatures for developing the comprehensive nomogram. The peritumoral dilation radiomics—the ultimate prediction model yielded satisfactory mean AUCs (training cohort: 0.939, 95% CI 0.908– 0.973; validation cohort: 0.842, 95% CI 0.736– 0.951) after 5-fold cross validation and fitted well with the actual relapse status in the calibration curve. Besides, our radiomics model obtained the best clinical net benefits, with significant improvements of NRI (35.9%-66.1%, P < 0.001) versus five clinical algorithms: the clinicoradiologic model, the tumor-node-metastasis classification, the Barcelona Clinic Liver Cancer stage, the preoperative and postoperative risks of Early Recurrence After Surgery for Liver tumor.Conclusion: Gd-EOB-DTPA MRI-based peritumoral dilation radiomics is a potential preoperative biomarker for early recurrence of HCC patients without macrovascular invasion.Keywords: gadoxetate disodium, hepatocellular carcinoma, radiomics, magnetic resonance imaging, neoplasm recurrence
