Radiomics-based model for predicting early recurrence of intrahepatic mass-forming cholangiocarcinoma after curative tumor resection

Abstract

To investigate the ability of CT-based radiomics signature for pre-and postoperatively predicting the early recurrence of intrahepatic mass-forming cholangiocarcinoma (IMCC) and develop radiomics-based prediction models. Institutional review board approved this study. Clinicopathological characteristics, contrast-enhanced CT images, and radiomics features of 125 IMCC patients (35 with early recurrence and 90 with non-early recurrence) were retrospectively reviewed. In the training set of 92 patients, preoperative model, pathological model, and combined model were developed by multivariate logistic regression analysis to predict the early recurrence (≤ 6 months) of IMCC, and the prediction performance of different models were compared using the Delong test. The developed models were validated by assessing their prediction performance in test set of 33 patients. Multivariate logistic regression analysis identified solitary, differentiation, energy- arterial phase (AP), inertia-AP, and percentile50th-portal venous phase (PV) to construct combined model for predicting early recurrence of IMCC [the area under the curve (AUC) = 0.917; 95% CI 0.840-0.965]. While the AUC of pathological model and preoperative model were 0.741 (95% CI 0.637-0.828) and 0.844 (95% CI 0.751-0.912), respectively. The AUC of the combined model was significantly higher than that of the preoperative model (p = 0.049) or pathological model (p = 0.002) in training set. In test set, the combined model also showed higher prediction performance. CT-based radiomics signature is a powerful predictor for early recurrence of IMCC. Preoperative model (constructed with homogeneity-AP and standard deviation-AP) and combined model (constructed with solitary, differentiation, energy-AP, inertia-AP, and percentile50th-PV) can improve the accuracy for pre-and postoperatively predicting the early recurrence of IMCC.

Figure 1

Flow chart showing inclusion and exclusion of subjects for this study. ICC intrahepatic cholangiocarcinoma, IMCC intrahepatic mass-forming cholangiocarcinoma, TACE transarterial chemoembolization, PEI percutaneous ethanol injection, RFA radiofrequency ablation.

Figure 2

Kaplan–Meier survival curves of IMCC patients with and without early recurrence in the training set (a) and test set (b).

Figure 3

Delong non-parametric approach, AUC estimates for predicting early recurrence of IMCC were compared between different prediction models in the training set (a) and test set (b).

Figure 4

Decision Curve Analysis in the training set (a) and test set (b), decision curves of the pathological model, preoperative model and combined model.