Retrospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 14, 2021; 27(2): 189-207
Published online Jan 14, 2021. doi: 10.3748/wjg.v27.i2.189
Development of a computed tomography-based radiomics nomogram for prediction of transarterial chemoembolization refractoriness in hepatocellular carcinoma
Xiang-Ke Niu, Xiao-Feng He
Xiang-Ke Niu, Xiao-Feng He, Department of Interventional Radiology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China
Xiang-Ke Niu, Department of Interventional Radiology, Affiliated Hospital of Chengdu University, Chengdu 610081, Sichuan Province, China
Author contributions: He XF designed the research study; He XF and Niu XK performed the research; Niu XK analyzed the data; Niu XK and He XF wrote the paper; all authors have read and approved the final manuscript.
Supported by Health and Family Planning Commission of Sichuan Province, China, No. 17PJ430 and No. 18PJ150.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of Affiliated Hospital of Chengdu University, approval No. PJ2019-019-01.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: The authors declare that there is no conflict of interest related to this study.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Xiao-Feng He, MD, Chief Doctor, Professor, Department of Interventional Radiology, Nanfang Hospital, Southern Medical University, No. 1838 North Guangzhou Avenue, Guangzhou 510515, Guangdong Province, China.
Received: November 2, 2020
Peer-review started: November 2, 2020
First decision: December 3, 2020
Revised: December 7, 2020
Accepted: December 16, 2020
Article in press: December 16, 2020
Published online: January 14, 2021
Research background

The point at which transarterial chemoembolization (TACE) should be continued or stopped is currently not addressed by any guideline to our knowledge. Repeated TACE cycles are, however, associated with an increase of related side effects and liver damage, potentially preventing an even greater survival advantage. In the era of personalized oncology, radiomics has allowed digitally encrypted medical images to be transformed into high-throughput quantitative features that provide information on patient prognosis.

Research motivation

In previous studies, patients with high Assessment for Retreatment with Transarterial Chemoembolization (ART) or α-fetoprotein, Barcelona Clinic Liver Cancer, Child-Pugh, and Response score (ABCR) scores tended to have a poor prognosis. Nonetheless, in terms of predictive ability, neither score was reliable enough to allow for clinical decision-making. Although previous studies have shown the prognostic value of computed tomography (CT) radiomic features for different cancer sites, there is scarcity of multi-centre radiomics research on TACE refractoriness.

Research objectives

The purpose of this study was to develop and validate a CT-based radiomics nomogram for the pre-treatment prediction of TACE refractoriness.

Research methods

Our study consisted of a training dataset (n = 137) and an external validation dataset (n = 81) of patients with clinically/pathologically confirmed hepatocellular carcinoma who underwent repeated TACE from March 2009 to March 2016. The radiomics features were retrospectively extracted from preoperative CT images of the arterial phase. The radiomics signature was built by least absolute shrinkage and selection operator (LASSO) regression. The CT-based radiomics nomogram incorporating clinical risk factors was built by multivariable logistic regression analysis. The performance of the nomogram was assessed with respect to its calibration, discrimination, and clinical usefulness. We used the concordance index to conduct head-to-head comparisons of the radiomics nomogram with the other four models (ART score, ABCR score, CT-based radiomics signature, and clinical model).

Research results

Eight features were selected to build the radiomics signature using the LASSO regression model. The CT-based radiomics nomogram included the radiomics score (HR = 3.9, 95% confidence interval: 3.1-8.8, P < 0.001) and four clinical factors and classified patients into high-risk (score > 3.5) and low-risk (score ≤ 3.5) groups with markedly different prognoses (overall survival: 12.3 mo vs 23.6 mo, P < 0.001). The accuracy of the nomogram was considerably higher than that of the other four models (ART score, ABCR score, CT-based radiomics signature, and clinical model). The calibration curve and decision curve analyses verified the usefulness of the CT-based radiomics nomogram for clinical practice.

Research conclusions

The CT-based radiomics nomogram is valuable in preoperatively predicting TACE refractoriness, which may aid interventional radiologist in determining the optimal treatment approach.

Research perspectives

First, additional information, such as gene sequence data or the molecular pathway, might be necessary for better interpretation of radiomics features, and this issue is left for future research. Second, larger prospective multicenter studies are needed to externally validate our newly constructed model in the future.