Tang YY, Zhao YN, Zhang T, Chen ZY, Ma XL. Comprehensive radiomics nomogram for predicting survival of patients with combined hepatocellular carcinoma and cholangiocarcinoma. World J Gastroenterol 2021; 27(41): 7173-7189 [PMID: 34887636 DOI: 10.3748/wjg.v27.i41.7173]
Corresponding Author of This Article
Zhe-Yu Chen, PhD, Chief Doctor, Full Professor, Postdoc, Surgeon, Surgical Oncologist, Department of Liver Surgery, Liver Transplantation Center, West China Hospital of Sichuan University, No. 37 Guoxue Street, Wuhou District, Chengdu 610041, Sichuan Province, China. chenzheyu@scu.edu.cn
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastroenterol. Nov 7, 2021; 27(41): 7173-7189 Published online Nov 7, 2021. doi: 10.3748/wjg.v27.i41.7173
Comprehensive radiomics nomogram for predicting survival of patients with combined hepatocellular carcinoma and cholangiocarcinoma
You-Yin Tang, Yu-Nuo Zhao, Tao Zhang, Zhe-Yu Chen, Xue-Lei Ma
You-Yin Tang, Zhe-Yu Chen, Department of Liver Surgery, Liver Transplantation Center, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
Yu-Nuo Zhao, Xue-Lei Ma, Department of Biotherapy, West China Hospital and State Key Laboratory of Biotherapy, Sichuan University, West China Hospital, Chengdu 610041, Sichuan Province, China
Tao Zhang, West China School of Medicine of Sichuan University, Chengdu 610041, Sichuan Province, China
Author contributions: Tang YY and Zhao YN provided the study concept and designed this study; Tang YY acquired the data; Zhang T and Zhao YN carried out data analysis and interpretation; Tang YY and Zhang T were responsible for drafting and preliminarily revising the manuscript; Ma XL and Chen ZY performed study supervision and final approval.
Institutional review board statement: This retrospective study was approved by the West China Hospital Ethics Committee (Approval No. 2019903).
Conflict-of-interest statement: The authors declare that they have no competing interests as defined by Nature Research, or other interests that might be perceived to influence the results and/or discussion reported in this paper.
Data sharing statement: The clinical data and radiomics data were available from the corresponding author at Chenzheyu@scu.edu.cn. And no additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Zhe-Yu Chen, PhD, Chief Doctor, Full Professor, Postdoc, Surgeon, Surgical Oncologist, Department of Liver Surgery, Liver Transplantation Center, West China Hospital of Sichuan University, No. 37 Guoxue Street, Wuhou District, Chengdu 610041, Sichuan Province, China. chenzheyu@scu.edu.cn
Received: April 2, 2021 Peer-review started: April 2, 2021 First decision: June 24, 2021 Revised: June 26, 2021 Accepted: September 3, 2021 Article in press: September 3, 2021 Published online: November 7, 2021 Processing time: 217 Days and 13.6 Hours
Abstract
BACKGROUND
Combined hepatocellular carcinoma (HCC) and cholangiocarcinoma (cHCC-CCA) is defined as a single nodule showing differentiation into HCC and intrahepatic cholangiocarcinoma and has a poor prognosis.
AIM
To develop a radiomics nomogram for predicting post-resection survival of patients with cHCC-CCA.
METHODS
Patients with pathologically diagnosed cHCC-CCA were randomly divided into training and validation sets. Radiomics features were extracted from portal venous phase computed tomography (CT) images using the least absolute shrinkage and selection operator Cox regression and random forest analysis. A nomogram integrating the radiomics score and clinical factors was developed using univariate analysis and multivariate Cox regression. Nomogram performance was assessed in terms of the C-index as well as calibration, decision, and survival curves.
RESULTS
CT and clinical data of 118 patients were included in the study. The radiomics score, vascular invasion, anatomical resection, total bilirubin level, and satellite lesions were found to be independent predictors of overall survival (OS) and were therefore included in an integrative nomogram. The nomogram was more strongly associated with OS (hazard ratio: 8.155, 95% confidence interval: 4.498-14.785, P < 0.001) than a model based on the radiomics score or only clinical factors. The area under the curve values for 1-year and 3-year OS in the training set were 0.878 and 0.875, respectively. Patients stratified as being at high risk of poor prognosis showed a significantly shorter median OS than those stratified as being at low risk (6.1 vs 81.6 mo, P < 0.001).
CONCLUSION
This nomogram may predict survival of cHCC-CCA patients after hepatectomy and therefore help identify those more likely to benefit from surgery.
Core Tip: Combined hepatocellular carcinoma (HCC) and cholangiocarcinoma (cHCC-CCA) is defined as a single nodule showing differentiation into HCC and intrahepatic cholangiocarcinoma. Studies vary regarding the prognosis of cHCC-CCA patients after potentially curative hepatectomy, with 5-year postoperative overall survival rates ranging from 8% to 63%. A reliable method to predict prognosis after resection may help select cHCC-CCA patients more likely to benefit from surgery. We established an integrative nomogram based on radiomics features and clinical variables to predict the survival of cHCC-CCA patients after potentially curative resection. The nomogram showed good predictive potential and may help guide treatment decisions.
