Zhang X, Zhang X, Luo QK, Fu Q, Liu P, Pan CJ, Liu CJ, Zhang HW, Qin T. Pretreatment radiomic imaging features combined with immunological indicators to predict targeted combination immunotherapy response in advanced hepatocellular carcinoma. World J Clin Oncol 2025; 16(4): 102735 [DOI: 10.5306/wjco.v16.i4.102735]
Corresponding Author of This Article
Tao Qin, PhD, Professor, Department of Hepato-Biliary-Pancreatic Surgery, Zhengzhou University People’s Hospital & Henan Provincial People’s Hospital, No. 7 Weiwu Road, Jinshui District, Zhengzhou 450003, Henan Province, China. goodfreecn@163.com
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 Clin Oncol. Apr 24, 2025; 16(4): 102735 Published online Apr 24, 2025. doi: 10.5306/wjco.v16.i4.102735
Pretreatment radiomic imaging features combined with immunological indicators to predict targeted combination immunotherapy response in advanced hepatocellular carcinoma
Xu Zhang, Xu Zhang, Qian-Kun Luo, Qiang Fu, Pan Liu, Chang-Jie Pan, Chuan-Jiang Liu, Hong-Wei Zhang, Tao Qin
Xu Zhang, Xu Zhang, Qian-Kun Luo, Qiang Fu, Pan Liu, Chang-Jie Pan, Chuan-Jiang Liu, Hong-Wei Zhang, Tao Qin, Department of Hepato-Biliary-Pancreatic Surgery, Zhengzhou University People’s Hospital & Henan Provincial People’s Hospital, Zhengzhou 450003, Henan Province, China
Co-first authors: Xu Zhang and Xu Zhang.
Co-corresponding authors: Hong-Wei Zhang and Tao Qin.
Author contributions: Zhang X (first) performed the majority of the experiments, and Zhang X (second) was responsible for article correction, they contributed equally as co-first authors; Luo QK conducted the experimental analysis; Fu Q provided vital reagents; Liu P and Pan CJ analyzed the data and developed the analysis tools; Liu CJ analyzed the clinical data; Zhang HW and Qin T supervised the research, they contributed equally as co-corresponding authors; and all authors have read and approved the final manuscript.
Supported by Natural Science Foundation of Henan Province, No. 242300421286; the research and practice project of higher education reform in Henan Province, No. 2023SJGLX124Y; and the research and practice project of higher education reform of Zhengzhou University, No. 2023ZZUJGXM114.
Institutional review board statement: This study was approved by the Ethics Committee of Zhengzhou University People’s Hospital (2022, Ethics No. 33).
Informed consent statement: This study is a retrospective study and meets the criteria for exemption from signing Informed Consent Form(s).
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The data that support the findings of this study are available on request from the corresponding author upon reasonable request.
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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Tao Qin, PhD, Professor, Department of Hepato-Biliary-Pancreatic Surgery, Zhengzhou University People’s Hospital & Henan Provincial People’s Hospital, No. 7 Weiwu Road, Jinshui District, Zhengzhou 450003, Henan Province, China. goodfreecn@163.com
Received: October 28, 2024 Revised: December 16, 2024 Accepted: January 23, 2025 Published online: April 24, 2025 Processing time: 150 Days and 2.4 Hours
Abstract
BACKGROUND
Early symptoms of hepatocellular carcinoma (HCC) are not obvious, and more than 70% of which does not receive radical hepatectomy, when first diagnosed. In recent years, molecular-targeted drugs combined with immunotherapy and other therapeutic methods have provided new treatment options for middle and advanced HCC (aHCC). Predicting the effect of targeted combined immunotherapy has become a hot topic in current research.
AIM
To explore the relationship between nodule enhancement in hepatobiliary phase and the efficacy of combined targeted immunotherapy for aHCC.
METHODS
Data from 56 patients with aHCC for magnetic resonance imaging with gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid were retrospectively collected. Signal intensity of intrahepatic nodules was measured, and the hepatobiliary relative enhancement ratio (RER) was calculated. Progression-free survival (PFS) of patients with high and low reinforcement of HCC nodules was compared. The model was validated using receiver operating characteristic curves. Univariate and multivariate logistic regression and Kaplan-Meier analysis were performed to explore factors influencing the efficacy of targeted immunization and PFS.
RESULTS
Univariate and multivariate analyses revealed that the RER, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and prognostic nutritional index were significantly associated with the efficacy of tyrosine kinase inhibitors combined with immunotherapy (P < 0.05). The area under the curve of the RER for predicting the efficacy of tyrosine kinase inhibitors combined with anti-programmed death 1 antibody in patients with aHCC was 0.876 (95% confidence interval: 0.781-0.971, P < 0.05), the optimal cutoff value was 0.904, diagnostic sensitivity was 87.5%, and specificity was 79.2%. Kaplan-Meier analysis showed that neutrophil-to-lymphocyte ratio < 5, platelet-to-lymphocyte ratio < 300, prognostic nutritional index < 45, and RER < 0.9 significantly improved PFS.
CONCLUSION
AHCC nodules enhancement in the hepatobiliary stage was significantly correlated with PFS. Imaging information and immunological indicators had high predictive efficacy for targeted combined immunotherapy and were associated with PFS.
Core Tip: In recent years, molecular-targeted drugs combined with immunotherapy and other therapeutic methods have provided new treatment options for mid-to-advanced hepatocellular carcinoma, and predicting the effect of targeted combined immunotherapy has become a hot topic in current research. The degree of enhancement of advanced hepatocellular carcinoma nodules in the hepatobiliary stage on gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging was significantly correlated with progression-free survival. The imaging information of nodules in the hepatobiliary stage and clinical immunological indicators have high predictive efficacy for targeted combined immunotherapy and are associated with progression-free survival in patients.
