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CT-based radiomics nomogram for prediction of survival after transarterial chemoembolization with drug-eluting beads in patients with hepatocellular carcinoma and portal vein tumor thrombus

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European Radiology Aims and scope Submit manuscript

Abstract

Objectives

To develop and validate a CT-based radiomics model for the prediction of the overall survival (OS) of patients with hepatocellular carcinoma (HCC) and portal vein tumor thrombus (PVTT) treated with drug-eluting beads transarterial chemoembolization (DEB-TACE).

Methods

Patients were retrospectively enrolled from two institutions for the constitution of training (n = 69) and validation (n = 31) cohorts with a median follow-up of 15 months. A total of 396 radiomics features were extracted from each baseline CT image. Features selected by variable importance and minimal depth were used for random survival forest model construction. The performance of the model was assessed using the concordance index (C-index), calibration curves, integrated discrimination index (IDI), net reclassification index (NRI), and decision curve analysis.

Results

Type of PVTT and tumor number were proved to be significant clinical indicators for OS. Arterial phase images were used to extract radiomics features. Three radiomics features were selected for model construction. The C-index for the radiomics model was 0.759 in the training cohort and 0.730 in the validation cohort. To improve the predictive performance, clinical indicators were integrated into the radiomics model to form a combined model with a C-index of 0.814 in the training cohort and 0.792 in the validation cohort. The IDI was significant in both cohorts for the combined model versus the radiomics model in predicting 12-month OS.

Conclusions

Type of PVTT and tumor number affected the OS of HCC patients with PVTT treated with DEB-TACE. Moreover, the combined clinical-radiomics model had a satisfactory performance.

Clinical relevance statement

A CT-based radiomics nomogram, which consisted of 3 radiomics features and 2 clinical indicators, was recommended to predict 12-month overall survival of patients with hepatocellular carcinoma and portal vein tumor thrombus initially treated with drug-eluting beads transarterial chemoembolization.

Key Points

• Type of portal vein tumor thrombus and tumor number were significant predictors of the OS.

• Integrated discrimination index and net reclassification index provided a quantitative evaluation of the incremental impact added by new indicators for the radiomics model.

• A nomogram based on a radiomics signature and clinical indicators showed satisfactory performance in predicting OS after DEB-TACE.

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Abbreviations

DEB:

Drug-eluting beads

GLCM:

Gray-level co-occurrence matrix

GLSZM:

Gray-level size zone matrix

IDI:

Integrated discrimination index

NRI:

Net reclassification index

PVTT:

Portal vein tumor thrombus

RLM:

Run-length matrix

ROI:

Region of interest

RSF:

Random survival forest

VIMP:

Variable importance

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Acknowledgements

We thank Dr. Siyun Liu for providing statistical advice.

Funding

This study was supported by Beijing Natural Science Foundation (7232116), National Natural Science Foundation of China (82202268 and 22232006), and National High Level Hospital Clinical Research Funding (2022-PUMCH-D-001).

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Author notes

  1. Sihang Cheng and Ge Hu contributed equally to this work.

Authors and Affiliations

  1. Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China

    Sihang Cheng, Zhengyu Jin, Zhiwei Wang & Huadan Xue

  2. Medical Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China

    Ge Hu

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Corresponding authors

Correspondence to Zhiwei Wang or Huadan Xue.

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Guarantor

The scientific guarantor of this publication is Zhiwei Wang.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

Dr. Ge Hu has significant statistical expertise.

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Written informed consent was waived by the Institutional Review Board.

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Study subjects or cohorts overlap

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• diagnostic or prognostic study

• multicenter study

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Cheng, S., Hu, G., Jin, Z. et al. CT-based radiomics nomogram for prediction of survival after transarterial chemoembolization with drug-eluting beads in patients with hepatocellular carcinoma and portal vein tumor thrombus. Eur Radiol 33, 8715–8726 (2023). https://doi.org/10.1007/s00330-023-09830-7

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