Clinical-radiomics predictors to identify the suitability of transarterial chemoembolization treatment in intermediate-stage hepatocellular carcinoma: A multicenter study
Dan-Dan Wang a , b , Jin-Feng Zhang c , Lin-Han Zhang d , Meng Niu e , Hui-Jie Jiang a , ∗, Fu-Cang Jia b , ∗, Shi-Ting Feng f , ∗
a Department of Radiology, the Second Affiliated Hospital of Harbin Medical University, Harbin 150086, China
b Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
c Department of Breast Surgery, Harbin Medical University Cancer Hospital, Harbin 150081, China
d Department of PET/CT, the First Affiliated Hospital of Harbin Medical University, Harbin 150007, China
e Department of Interventional Therapy, the First Affiliated Hospital of China Medical University, Shenyang 110001, China
f Department of Radiology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
Abstract：Background: Although transarterial chemoembolization (TACE) is the first-line therapy for intermediate-stage hepatocellular carcinoma (HCC), it is not suitable for all patients. This study aimed to determine how to select patients who are not suitable for TACE as the first treatment choice.
Methods: A total of 243 intermediate-stage HCC patients treated with TACE at three centers were retrospectively enrolled, of which 171 were used for model training and 72 for testing. Radiomics features were screened using the Spearman correlation analysis and the least absolute shrinkage and selection operator (LASSO) algorithm. Subsequently, a radiomics model was established using extreme gradient boosting (XGBoost) with 5-fold cross-validation. The Shapley additive explanations (SHAP) method was used to visualize the radiomics model. A clinical model was constructed using univariate and multivariate logistic regression. The combined model comprising the radiomics signature and clinical factors was then established. This model’s performance was evaluated by discrimination, calibration, and clinical application. Generalization ability was evaluated by the testing cohort. Finally, the model was used to analyze overall and progression-free survival of different groups.
Results: A third of the patients (81/243) were unsuitable for TACE treatment. The combined model had a high degree of accuracy as it identified TACE-unsuitable cases, at a sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) of 0.759, 0.885, 0.906 [95% confidence interval (CI): 0.859-0.953] in the training cohort and 0.826, 0.776, and 0.894 (95% CI: 0.815-0.972) in the testing cohort, respectively.
Conclusions: The high degree of accuracy of our clinical-radiomics model makes it clinically useful in identifying intermediate-stage HCC patients who are unsuitable for TACE treatment.
2023, Vol. 22 
