Published online May 15, 2025. doi: 10.4251/wjgo.v17.i5.105872
Revised: March 27, 2025
Accepted: April 17, 2025
Published online: May 15, 2025
Processing time: 96 Days and 0.1 Hours
Hepatocellular carcinoma (HCC) is a major global contributor to cancer-related mortality, with advanced stages presenting substantial therapeutic challenges. Although targeted immunotherapy shows potential, many patients exhibit poor responses, underscoring the need for predictive tools to optimize treatment strategies. Emerging data indicate that ultrasound features (e.g., tumor stiffness) and serum biomarkers may serve as predictors of treatment outcomes. However, an integrated model for these predictors remains unavailable. This paper introduces a machine learning-based approach that combines ultrasound and serological data to forecast immunotherapy efficacy in patients with advanced HCC.
To develop a non-invasive predictive model for targeted immunotherapy in advanced HCC, incorporating both internal and external validation.
Patients with advanced HCC who received targeted immunotherapy at two medical centers were enrolled and divided into internal training, internal validation, and external validation cohorts. Comprehensive clinical data were gathered. Initially, 13 machine learning algorithms were tested using the internal training cohort. The algorithm yielding the highest area under the curve (AUC) in the internal validation cohort was selected to construct a predictive model, termed the Target Immunotherapy Predictive Model (TIPM). TIPM performance was then compared with that of traditional tumor staging systems (tumor-node-metastasis, Barcelona Clinic Liver Cancer, China Liver Cancer, Hong Kong Liver Cancer, and C-reactive protein and alpha-fetoprotein in immunotherapy).
A total of 306 patients participated in the study, with 143 in the internal training cohort, 62 in the internal validation cohort, and 101 in the external validation cohort. In the internal validation cohort, the random forest model achieved the highest AUC (0.975, 95% confidence interval: 0.924-0.998). The key predictors for TIPM were tumor size, platelet count, tumor stiffness change, and white blood cell count. During external validation, TIPM outperformed conventional models, reaching an AUC of 0.899 (95% confidence interval: 0.840-0.957). Calibration curves demonstrated strong concordance with observed outcomes, while decision curve analysis confirmed TIPM’s enhanced clinical value. Additional metrics, such as the net reclassification index and integrated discrimination improvement, further supported TIPM’s superior predictive accuracy.
TIPM provides a robust tool for predicting targeted immunotherapy efficacy in advanced HCC, facilitating personalized treatment planning.
Core Tip: Predicting treatment response in patients with advanced hepatocellular carcinoma undergoing targeted immunotherapy remains a significant challenge. This study developed and validated the Target Immunotherapy Predictive Model, a novel, non-invasive tool that integrates pre-treatment ultrasound features (tumor diameter, changes in tumor stiffness) and accessible serum biomarkers (platelet count, white blood cell count) using machine learning. The Target Immunotherapy Predictive Model outperformed traditional staging systems in predicting treatment efficacy, providing a promising solution for personalized treatment selection in advanced hepatocellular carcinoma. This approach has the potential to minimize unnecessary treatments, optimize therapeutic strategies, and ultimately improve patient outcomes. A user-friendly web calculator further enhances its clinical applicability.