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Predicting the Initial Treatment Response to Transarterial Chemoembolization in Intermediate-Stage Hepatocellular Carcinoma by the Integration of Radiomics and Deep Learning

ABSTRACT:

Objectives

We aimed to develop radiology-based models for the preoperative prediction of the initial treatment response to transarterial chemoembolization (TACE) in patients with hepatocellular carcinoma (HCC) since the integration of radiomics and deep learning (DL) has not been reported for TACE.

Methods

Three hundred and ten intermediate-stage HCC patients who underwent TACE were recruited from three independent medical centers. Based on computed tomography (CT) images, recursive feature elimination (RFE) was used to select the most useful radiomics features. Five radiomics conventional machine learning (cML) models and a DL model were used for training and validation. Mutual correlations between each model were analyzed. The accuracies of integrating clinical variables, cML, and DL models were then evaluated.

Results

Good predictive accuracies were showed across the two cohorts in the five cML models, especially the random forest algorithm (AUC = 0.967 and 0.964, respectively). DL showed high accuracies in the training and validation cohorts (AUC = 0.981 and 0.972, respectively). Significant mutual correlations were revealed between tumor size and the five cML models and DL model (each P < 0.001). The highest accuracies were achieved by integrating DL and the random forest algorithm in the training and validation cohorts (AUC = 0.995 and 0.994, respectively).

Conclusion

The radiomics cML models and DL model showed notable accuracy for predicting the initial response to TACE treatment. Moreover, the integrated model could serve as a novel and accurate method for prediction in intermediate-stage HCC.

SUBMITTER: Peng J

PROVIDER: S-EPMC8566880 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BACKGROUND:Liver cancer is the fifth most common cancer and the second cause of cancer-related deaths worldwide. Transarterial chemoembolization (TACE) is the best treatment of intermediate hepatocellular carcinoma (HCC). Doxorubicin is the most commonly used drug despite a low level of evidence. AIM:To compare the objective response rate of idarubicin-based TACE (Ida-TACE) against doxorubicin-based TACE (Dox-TACE) in intermediate stage HCC. METHODS:Between January 2012 and December 2014, all patients treated with TACE at our academic hospital were screened. Inclusion criteria were patients with Child-Pugh score A or B, a performance status below or equal to 1, and no prior TACE. Either lipiodol TACE or drug-eluting beads TACE could be performed with 10 mg of idarubicin or 50 mg of doxorubicin. Each patient treated with idarubicin was matched with two doxorubicin-treated patients. The TACE response was assessed by independent radiologists according to the mRECIST criteria. RESULTS:Sixty patients were treated with doxorubicin and thirty with idarubicin. There were 93% and 87% of cirrhotic patients and 87% and 70% of Child-Pugh A in the doxorubicin and idarubicin groups, respectively. The median number of HCC per patient was two in both groups with 31% and 26% of single nodules in doxorubicin and idarubicin groups, respectively. Objective response rate after first TACE was 76.7% and 73.3% (P = 0.797) with 41.7% and 40.0% complete response in doxorubicin and idarubicin groups, respectively. Progression-free survival was 7.7 mo in both groups, and liver transplant-free survival was 24.9 mo and 21.9 mo in doxorubicin and idarubicin groups, respectively. Safety profiles were similar in both groups, with grade 3-4 adverse events in 35% of Dox-TACE and 43% of Ida-TACEs. CONCLUSION:Ida-TACE and Dox-TACE showed comparable results in terms of efficacy and safety. Ida-TACE may represent an interesting alternative to Dox-TACE in the management of patients with intermediate stage HCC.