Background
Methods
Patient selection and data collection
Quantitative imaging characteristics
Inter-observer and intra-observer reproducibility of radiomics feature extraction
Feature selection and rad-score building
Statistical analysis
Results
Clinical characteristics of the patients
Variable | Training cohort | Validation cohort |
p
|
---|---|---|---|
Median(range) age, y | 55(24–85) | 55(13–83) | 0.93 |
Gender (male/female) | 175/37 | 88/19 | 0.95 |
Tumor size(≤3,> 3), cm | 76/133 | 38/69 | 0.82 |
Vascular invasion(Present/Absent) | 22/190 | 12/95 | 0.82 |
Microvascular invasion(Present/Absent) | 68/144 | 29/78 | 0.36 |
Tumor differentiation (III-IV/I-II) | 16/193 | 6/101 | 0.46 |
Liver cirrhosis(Present/Absent) | 166/46 | 87/20 | 0.53 |
HbsAg (Positive/Negative) | 178/34 | 85/22 | 0.32 |
Tumor encapsulation (Present/ Absent) | 112/110 | 59/48 | 0.70 |
Preoperative blood test | |||
DBIL(mean ± SD), μmol/L | 6.9 ± 11.9 | 7.3 ± 16.4 | 0.45 |
TBIL(mean ± SD), μmol/L | 14.8 ± 14.5 | 15.04 ± 19.2 | 0.94 |
ALT(mean ± SD), U/L | 40.1 ± 31.3 | 46.1 ± 69.2 | 0.91 |
AST(mean ± SD), U/L | 38.7 ± 27.3 | 453.6 ± 66.3 | 0.67 |
AFP(mean ± SD), ng/ml | 4460 ± 13,186 | 3800 ± 12,646 | 0.60 |
ALB(mean ± SD), g/L | 40.7 ± 7.0 | 39.8 ± 3.6 | 0.06 |
GGT(mean ± SD), U/L | 84.3 ± 98.8 | 80.8 ± 83.5 | 0.38 |
Results of inter-observer and intra-observer reproducibility of radiomics feature extraction
Development of the rad-score and its association with clinicopathological features
Low rad-score correlated with poor survival in solitary HCC patients
Variables | Training cohort | Validation cohort | ||||||||
---|---|---|---|---|---|---|---|---|---|---|
Univariate | Multivariate | Multivariate | ||||||||
HR | 95%CI |
p
| HR | 95%CI |
p
| HR | 95%CI |
p
| ||
Gender | Male | 1.131 | 0.672–1.903 | 0.642 | \ | \ | \ | \ | \ | \ |
Female | ||||||||||
Tumor size | ≤3 cm | 1.831 | 1.190–2.817 | 0.006 | \ | \ | 0.193 | \ | \ | 0.167 |
> 3 cm | ||||||||||
Vascular invasion | Present | 2.364 | 1.341–4.166 | 0.003 | 2.602 | 1.408–4.807 | 0.002 | \ | \ | 0.141 |
Absent | ||||||||||
Microvascular invasion | Present | 1.285 | 0.858–1.926 | 0.223 | \ | \ | \ | \ | \ | \ |
Absent | ||||||||||
Differentiation | III-IV | 1.242 | 0.871–1.772 | 0.231 | \ | \ | \ | \ | \ | \ |
I-II | ||||||||||
Liver Cirrhosis | YES | 1.076 | 0.89–1.301 | 0.451 | \ | \ | \ | \ | \ | \ |
NO | ||||||||||
HBsAg | Positive | 1.292 | 0.747–2.233 | 0.359 | \ | \ | \ | \ | \ | \ |
Negative | ||||||||||
Tumor encapsulation | Present | 1.533 | 1.032–2.277 | 0.034 | 1.637 | 1.074–2.494 | 0.022 | \ | \ | 0.975 |
Absent | ||||||||||
Rad-score | ≤4.32 | 1.779 | 1.174–2.703 | 0.007 | 1.558 | 1.022–2.375 | 0.039 | 1.890 | 1.041–3.436 | 0.036 |
> 4.32 | ||||||||||
DBIL, μmol/L | 1.002 | 0.986–1.019 | 0.797 | \ | \ | \ | \ | \ | \ | |
TBIL, μmol/L | 1.003 | 0.99–1.015 | 0.691 | \ | \ | \ | \ | \ | \ | |
ALT, U/L | 1.001 | 0.998–1.004 | 0.624 | \ | \ | \ | \ | \ | \ | |
AST, U/L | 1.001 | 0.999–1.004 | 0.339 | \ | \ | \ | \ | \ | \ | |
AFP, ng/ml | 1.000 | 1.000–1.000 | 0.494 | \ | \ | \ | \ | \ | \ | |
ALB, g/L | 1.020 | 0.986–1.055 | 0.253 | \ | \ | \ | \ | \ | \ | |
GGT, U/L | 1.002 | 1.001–1.004 | 0.002 | 1.002 | 1.000–1.003 | 0.017 | \ | \ | 0.426 |
Variables | Training cohort | Validation cohort | ||||||||
---|---|---|---|---|---|---|---|---|---|---|
Univariate analysis | Multivariate analysis | Multivariate analysis | ||||||||
HR | 95%CI |
p
| HR | 95%CI |
p
| HR | 95%CI |
p
| ||
Gender | Male | 0.931 | 0.451–1.923 | 0.847 | \ | \ | \ | |||
Female | ||||||||||
Tumor size(cm) | ≤3 | 2.822 | 1.406–5.650 | 0.004 | 1.910 | 0.897–4.070 | 0.035 | \ | \ | 0.139 |
> 3 | ||||||||||
Vascular invasion | Present | 3.52 | 1.701–7.287 | 0.001 | 1.794 | 0.797–4.037 | 0.008 | \ | \ | 0.982 |
Absent | ||||||||||
Micro-vascular invasion | Present | 1.084 | 0.574–2.051 | 0.803 | \ | \ | \ | \ | \ | \ |
Absent | ||||||||||
Differentiation | III-IV | 1.515 | 0.886–2.592 | 0.129 | \ | \ | \ | \ | \ | \ |
I-II | ||||||||||
Liver Cirrhosis | Yes | 1.113 | 0.838–1.479 | 0.458 | \ | \ | \ | \ | \ | \ |
No | ||||||||||
HBsAg | Present | 1.557 | 0.662–3.664 | 0.31 | \ | \ | \ | \ | \ | \ |
Absent | ||||||||||
Tumor encapsulation | Absent | 2.105 | 1.155–3.846 | 0.015 | 2.326 | 1.272–4.255 | 0.006 | \ | \ | 0.394 |
Present | ||||||||||
Rad-score | ≤4.32 | 2.387 | 1.321–4.310 | 0.004 | 2.283 | 1.261–4.132 | 0.006 | 3.236 | 1.416–7.407 | 0.005 |
> 4.32 | ||||||||||
DBIL, μmol/L | 1.015 | 0.998–1.031 | 0.084 | \ | \ | \ | \ | \ | ||
TBIL, μmol/L | 1.012 | 0.998–1.026 | 0.102 | \ | \ | \ | \ | \ | \ | |
ALT, U/L | 0.998 | 0.991–1.005 | 0.57 | \ | \ | \ | \ | \ | \ | |
AST, U/L | 1.000 | 0.995–1.005 | 0.946 | \ | \ | \ | \ | \ | \ | |
AFP, ng/ml | 1.000 | 1.000–1.000 | 0.189 | \ | \ | \ | \ | \ | \ | |
ALB, g/L | 1.020 | 0.964–1.079 | 0.495 | \ | \ | \ | \ | \ | \ | |
GGT, U/L | 1.004 | 1.003–1.006 | < 0.0001 | 1.004 | 1.002–1.006 | < 0.0001 | \ | \ | 0.249 |
The performance of rad-score based prognostic nomograms
Training cohort | Validation cohort | |||||||
---|---|---|---|---|---|---|---|---|
TTR | OS | TTR | OS | |||||
C-index | 95%CI | C-index | 95%CI | C-index | 95%CI | C-index | 95%CI | |
Rad-score | 0.563 | 0.516–0.610 | 0.541 | 0.488–0.594 | 0.555 | 0.491–0.619 | 0.629 | 0.529–0.729 |
Rad-score based nomograms | 0.639 | 0.577–0.701 | 0.714 | 0.635–0.793 | 0.587 | 0.479–0.695 | 0.710 | 0.602–0.818 |
Clinical-pathological nomograms | 0.633 | 0.571–0.695 | 0.554 | 0.485–0.623 | 0.601 | 0.592–0.610 | 0.642 | 0.532–0.752 |
Rad-score-TNM nomogram | 0.584 | 0.531–0.637 | 0.626 | 0.549–0.703 | 0.601 | 0.530–0.672 | 0.617 | 0.507–0.727 |
Rad-score-BCLC nomogram | 0.580 | 0.526–0.634 | 0.627 | 0.549–0.705 | 0.601 | 0.523–0.679 | 0.622 | 0.509–0.735 |
Traditional staging system | ||||||||
TNM | 0.552 | 0.513–0.581 | 0.575 | 0.515–0.635 | 0.553 | 0.499–0.607 | 0.521 | 0.453–0.589 |
BCLC | 0.547 | 0.506–0.588 | 0.574 | 0.511–0.637 | 0.548 | 0.485–0.611 | 0.506 | 0.420–0.592 |
JIS | 0.554 | 0.508–0.600 | 0.601 | 0.533–0.669 | 0.564 | 0.503–0.625 | 0.574 | 0.504–0.644 |
HKLC | 0.575 | 0.529–0.631 | 0.628 | 0.620–0.636 | 0.582 | 0.507–0.657 | 0.596 | 0.487–0.701 |