Prediction of the efficacy of first transarterial chemoembolization for advanced hepatocellular carcinoma via a clinical-radiomics model

Table 1 Clinical information of the training and validation cohorts, n (%)/mean ± SD

Characteristics	Training cohort (n = 85)	Validation cohort (n = 37)	P value
Sex			0.430
Male	73 (85.9)	33 (89.2)
Female	12 (14.1)	4 (10.8)
Age	54.35 ± 10.930	57.43 ± 10.219	0.147
Child-Pugh class			0.213
A	67 (78.8)	26 (70.3)
B	18 (21.2)	11 (29.7)
Hepatitis			0.040
None	4 (4.7)	1 (2.7)
Hepatitis B	79 (92.9)	32 (86.5)
Hepatitis C	1 (1.2)	1 (2.7)
Alcoholic hepatitis	1 (1.2)	3 (8.5)
PT (s)			0.458
≤ 14	80 (94.1)	34 (91.9)
> 14	5 (5.9)	3 (8.1)
TB (μmol/L)			0.173
≤ 17.1	41 (48.2)	22 (59.5)
> 17.1	44 (51.8)	15 (40.5)
ALB (g/L)			0.144
≤ 35	45 (52.9)	15 (40.5)
> 35	40 (47.1)	22 (59.5)
AST (U/L)			0.357
≤ 40	18 (21.2)	6 (16.2)
> 40	67 (78.8)	31 (83.8)
ALT (U/L)			0.194
≤ 50	59 (69.4)	22 (59.5)
> 50	26 (30.6)	15 (40.5)
AFP (ng/mL)			0.326
≤ 400	27 (31.8)	14 (37.8)
> 400	58 (68.2)	23 (62.2)

PT: Prothrombin time; TB: Total bilirubin; ALB: Albumin; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; AFP: Alpha-fetoprotein.

Table 2 Imaging features of the training and validation cohorts, n (%)/mean ± SD

Characteristics	Training cohort (n = 85)	Validation cohort (n = 37)	P value
Diameter (mm)	95.04 ± 32.988	92.97 ± 35.158	0.752
Number of tumors			0.351
One	37 (43.5)	14 (37.8)
Multiple	48 (56.5)	23 (62.2)
Location			0.516
Right	59 (69.4)	25 (67.6)
Left	23 (27.1)	12 (62.4)
Caudate lobe	3 (3.5)	0 (0)
Envelope			0.409
Absent	31 (36.5)	15 (40.5)
Present	54 (63.5)	22 (59.5)
Tumor necrosis			0.279
Absent	17 (20.0)	5 (13.5)
Present	68 (80.0)	32 (86.5)
Intratumoral hemorrhage			0.598
Absent	76 (89.4)	33 (89.2)
Present	9 (10.6)	4 (10.8)
Tumor rupture			0.074
Absent	78 (91.8)	37 (100.0)
Present	7 (8.2)	0 (0)
Portal vein thrombosis			0.129
Absent	39 (45.9)	11 (29.7)
Present	46 (54.1)	26 (70.3)

Table 3 Relationships between the clinical characteristics of the training cohort and the efficacy of transarterial chemoembolization treatment, n (%)/mean ± SD

Characteristics	Effective (n = 50)	Invalid (n = 35)	P value
Sex			0.36
Male	44 (82.9)	29 (82.9)
Female	6 (17.1)	6 (17.1)
Age	55.74 ± 10.764	52.37 ± 11.014	0.163
Child-Pugh class			0.523
A	39 (78.0)	28 (80.0)
B	11 (22.0)	7 (20.0)
Hepatitis			0.511
None	2 (4)	2 (18.4)
Hepatitis B	47 (94)	32 (26.3)
Hepatitis C	1 (2)	0 (31.6)
Alcoholic hepatitis	0 (0)	1 (23.7)
PT(s)			0.090
≤ 14	49 (98.0)	31 (88.6)
> 14	1 (2.0)	4 (11.4)
TB (μmol/L)			0.567
≤ 17.1	24 (48.0)	17 (48.6)
> 17.1	26 (52.0)	18 (51.4)
ALB (g/L)			0.192
≤ 35	24 (48.0)	21 (60.0)
> 35	26 (52.0)	14 (40.0)
AST (U/L)			0.151
≤ 40	13 (26.0)	5 (14.3)
> 40	37 (74.0)	30 (85.7)
ALT (U/L)			0.463
≤ 50	34 (68.0)	25 (71.4)
> 50	16 (32.0)	10 (28.6)
AFP (ng/mL)			0.003
≤ 400	22 (44.0)	5 (14.3)
> 400	28 (56.0)	30 (85.7)

PT: Prothrombin time; TB: Total bilirubin; ALB: Albumin; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; AFP: Alpha-fetoprotein.

Table 4 Relationships between the imaging characteristics of the training cohort and the efficacy of transarterial chemoembolization treatment, n (%)/mean ± SD

Characteristics	Effective (n = 50)	Invalid (n = 35)	P value
Diameter (mm)	94.42 ± 33.742	95.91 ± 32.347	0.839
Number of tumors			0.157
One	19 (38.0)	18 (51.4)
Multiple	31 (62.0)	17 (48.6)
Location			0.567
Right	35 (70.0)	24 (68.6)
Left	13 (26.0)	10 (28.6)
Caudate lobe	2 (4.0)	1 (2.9)
Envelope			0.100
Absent	15 (30.0)	16 (45.7)
Present	35 (70.0)	19 (54.3)
Tumor necrosis			0.395
Absent	11 (22.0)	6 (17.1)
Present	39 (78.0)	29 (82.9)
Intratumoral hemorrhage			0.551
Absent	45 (90.0)	31 (88.6)
Present	5 (10.0)	4 (11.4)
Tumor rupture			0.612
Absent	46 (92.0)	32 (91.4)
Present	4 (8.0)	3 (8.6)
Portal vein thrombosis			0.073
Absent	26 (52.0)	13 (37.1)
Present	24 (48.0)	22 (62.9)

Table 5 Results of the multifactorial logistic regression analysis of the efficacy of transarterial chemoembolization treatment

Characteristics	OR	95%CI	P value
Portal vein thrombosis	4.906	0.662-36.352	0.421
AFP	4.710	1.438-15.420	0.010
PT	7.308	0.707-75.488	0.095
Envelope	0.701	0.223-2.206	0.543

OR: Odds ratio; PT: Prothrombin time; AFP: Alpha-fetoprotein.

Table 6 Comparison between the training and validation cohorts of the radiomics models

Model	Training cohort (n = 85)				Validation cohort (n = 37)
	AUC	95%CI	Sensitivity%	Specificity%	AUC	95%CI	Sensitivity%	Specificity%
Arterial phase	0.885	0.814-0.955	0.829	0.613	0.592	0.400-0.783	0.476	0.428
Venous phase	0.867	0.790-0.940	0.863	0.686	0.755	0.600-0.910	0.818	0.533
Arteria + venous phase	0.84	0.758-0.923	0.823	0.657	0.645	0.461-0.829	0.590	0.467
Peritumor 5- mm (venous phase)	0.866	0.791-0.941	0.863	0.656	0.594	0.402-0.786	0.591	0.667
Peritumor 10- mm (venous phase)	0.922	0.866-0.977	0.921	0.686	0.603	0.408-0.799	0.682	0.467

AUC: Area under the curve.

Table 7 Comparison of the performance of different predictive models using the DeLong test in the training and validation cohorts

Cohort	Model comparison	P value
Training cohort	Clinical model vs radiomics model	< 0.023
	Clinical model vs combined model	< 0.015
	Radiomics model vs combined model	0.453
Validation cohort	Clinical model vs radiomics model	< 0.036
	Clinical model vs combined model	< 0.021
	Radiomics model vs combined model	0.632