1
|
He L, Ji WS, Jin HL, Lu WJ, Zhang YY, Wang HG, Liu YY, Qiu S, Xu M, Lei ZP, Zheng Q, Yang XL, Zhang Q. Development of a nomogram for predicting liver transplantation prognosis in hepatocellular carcinoma. World J Gastroenterol 2024; 30:2763-2776. [PMID: 38899335 PMCID: PMC11185292 DOI: 10.3748/wjg.v30.i21.2763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 04/24/2024] [Accepted: 05/13/2024] [Indexed: 06/03/2024] Open
Abstract
BACKGROUND At present, liver transplantation (LT) is one of the best treatments for hepatocellular carcinoma (HCC). Accurately predicting the survival status after LT can significantly improve the survival rate after LT, and ensure the best way to make rational use of liver organs. AIM To develop a model for predicting prognosis after LT in patients with HCC. METHODS Clinical data and follow-up information of 160 patients with HCC who underwent LT were collected and evaluated. The expression levels of alpha-fetoprotein (AFP), des-gamma-carboxy prothrombin, Golgi protein 73, cytokeratin-18 epitopes M30 and M65 were measured using a fully automated chemiluminescence analyzer. The best cutoff value of biomarkers was determined using the Youden index. Cox regression analysis was used to identify the independent risk factors. A forest model was constructed using the random forest method. We evaluated the accuracy of the nomogram using the area under the curve, using the calibration curve to assess consistency. A decision curve analysis (DCA) was used to evaluate the clinical utility of the nomograms. RESULTS The total tumor diameter (TTD), vascular invasion (VI), AFP, and cytokeratin-18 epitopes M30 (CK18-M30) were identified as important risk factors for outcome after LT. The nomogram had a higher predictive accuracy than the Milan, University of California, San Francisco, and Hangzhou criteria. The calibration curve analyses indicated a good fit. The survival and recurrence-free survival (RFS) of high-risk groups were significantly lower than those of low- and middle-risk groups (P < 0.001). The DCA shows that the model has better clinical practicability. CONCLUSION The study developed a predictive nomogram based on TTD, VI, AFP, and CK18-M30 that could accurately predict overall survival and RFS after LT. It can screen for patients with better postoperative prognosis, and improve long-term survival for LT patients.
Collapse
Affiliation(s)
- Li He
- Department of Organ Transplantation, The Third Medical Centre of Chinese PLA General Hospital, Beijing 100039, China
- School of Clinical Medicine, Shandong Second Medical University, Weifang 261053, Shandong Province, China
| | - Wan-Sheng Ji
- Clinical Research Center, The Affiliated Hospital of Shandong Second Medical University, Weifang 261053, Shandong Province, China
| | - Hai-Long Jin
- Department of Organ Transplantation, The Third Medical Centre of Chinese PLA General Hospital, Beijing 100039, China
| | - Wen-Jing Lu
- Department of Laboratory Medicine, The Third Medical Centre of Chinese PLA General Hospital, Beijing 100039, China
| | - Yuan-Yuan Zhang
- Department of Laboratory Medicine, The Third Medical Centre of Chinese PLA General Hospital, Beijing 100039, China
| | - Hua-Guang Wang
- Physiatry Department, Naval Aviation University, Yantai 100071, Shandong Province, China
| | - Yu-Yu Liu
- Department of Organ Transplantation, The Third Medical Centre of Chinese PLA General Hospital, Beijing 100039, China
| | - Shuang Qiu
- Department of Organ Transplantation, The Third Medical Centre of Chinese PLA General Hospital, Beijing 100039, China
| | - Meng Xu
- Department of Organ Transplantation, The Third Medical Centre of Chinese PLA General Hospital, Beijing 100039, China
| | - Zi-Peng Lei
- Department of Organ Transplantation, The Third Medical Centre of Chinese PLA General Hospital, Beijing 100039, China
| | - Qian Zheng
- Department of Organ Transplantation, The Third Medical Centre of Chinese PLA General Hospital, Beijing 100039, China
| | - Xiao-Li Yang
- Department of Laboratory Medicine, The Third Medical Centre of Chinese PLA General Hospital, Beijing 100039, China
| | - Qing Zhang
- Department of Organ Transplantation, The Third Medical Centre of Chinese PLA General Hospital, Beijing 100039, China
| |
Collapse
|
2
|
Grut H, Line PD, Syversveen T, Dueland S. Metabolic Tumor Volume from 18F-FDG PET/CT in Combination with Radiologic Measurements to Predict Long-Term Survival Following Transplantation for Colorectal Liver Metastases. Cancers (Basel) 2023; 16:19. [PMID: 38201449 PMCID: PMC10777966 DOI: 10.3390/cancers16010019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 12/13/2023] [Accepted: 12/16/2023] [Indexed: 01/12/2024] Open
Abstract
The aim of the present study is to report on the ability of metabolic tumor volume (MTV) of liver metastases from pre-transplant 18F-FDG PET/CT in combination with conventional radiological measurements from CT scans to predict long-term disease-free survival (DFS), overall survival (OS), and survival after relapse (SAR) after liver transplantation for colorectal liver metastases. The total liver MTV was obtained from the 18F-FDG PET/CT, and the size of the largest metastasis and the total number of metastases were obtained from the CT. DFS, OS, and SAR for patients with a low and high MTV, in combination with a low and high size, number, and tumor burden score, were compared using the Kaplan-Meier method and log-rank test. Patients with a low number of metastases and low MTV had a significantly longer OS than those with a high MTV, with a median survival of 151 vs. 26 months (p = 0.010). Patients with a high number of metastases and low MTV had significantly longer DFS, OS, and SAR than patients with a high MTV (p = 0.034, 0.006, and 0.026). The tumor burden score of group/zone 3, in combination with a low MTV, had a significantly improved DFS, OS, and SAR compared to those with a high MTV (p = 0.034, <0.001, and 0.006). Patients with a low MTV of liver metastases had a long DFS, OS, and SAR despite a high number of liver metastases and a high tumor burden score.
Collapse
Affiliation(s)
- Harald Grut
- Department of Radiology, Vestre Viken Hospital Trust, 3004 Drammen, Norway
| | - Pål-Dag Line
- Institute of Clinical Medicine, University of Oslo, 0424 Oslo, Norway
- Department of Transplantation Medicine, Oslo University Hospital, 0424 Oslo, Norway
| | - Trygve Syversveen
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, 0424 Oslo, Norway
| | - Svein Dueland
- Department of Transplantation Medicine, Oslo University Hospital, 0424 Oslo, Norway
| |
Collapse
|
3
|
Yan M, Zhang X, Zhang B, Geng Z, Xie C, Yang W, Zhang S, Qi Z, Lin T, Ke Q, Li X, Wang S, Quan X. Deep learning nomogram based on Gd-EOB-DTPA MRI for predicting early recurrence in hepatocellular carcinoma after hepatectomy. Eur Radiol 2023; 33:4949-4961. [PMID: 36786905 PMCID: PMC10289921 DOI: 10.1007/s00330-023-09419-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 12/26/2022] [Accepted: 01/01/2023] [Indexed: 02/15/2023]
Abstract
OBJECTIVES The accurate prediction of post-hepatectomy early recurrence in patients with hepatocellular carcinoma (HCC) is crucial for decision-making regarding postoperative adjuvant treatment and monitoring. We aimed to explore the feasibility of deep learning (DL) features derived from gadoxetate disodium (Gd-EOB-DTPA) MRI, qualitative features, and clinical variables for predicting early recurrence. METHODS In this bicentric study, 285 patients with HCC who underwent Gd-EOB-DTPA MRI before resection were divided into training (n = 195) and validation (n = 90) sets. DL features were extracted from contrast-enhanced MRI images using VGGNet-19. Three feature selection methods and five classification methods were combined for DL signature construction. Subsequently, an mp-MR DL signature fused with multiphase DL signatures of contrast-enhanced images was constructed. Univariate and multivariate logistic regression analyses were used to identify early recurrence risk factors including mp-MR DL signature, microvascular invasion (MVI), and tumor number. A DL nomogram was built by incorporating deep features and significant clinical variables to achieve early recurrence prediction. RESULTS MVI (p = 0.039), tumor number (p = 0.001), and mp-MR DL signature (p < 0.001) were independent risk factors for early recurrence. The DL nomogram outperformed the clinical nomogram in the training set (AUC: 0.949 vs. 0.751; p < 0.001) and validation set (AUC: 0.909 vs. 0.715; p = 0.002). Excellent DL nomogram calibration was achieved in both training and validation sets. Decision curve analysis confirmed the clinical usefulness of DL nomogram. CONCLUSION The proposed DL nomogram was superior to the clinical nomogram in predicting early recurrence for HCC patients after hepatectomy. KEY POINTS • Deep learning signature based on Gd-EOB-DTPA MRI was the predominant independent predictor of early recurrence for hepatocellular carcinoma (HCC) after hepatectomy. • Deep learning nomogram based on clinical factors and Gd-EOB-DTPA MRI features is promising for predicting early recurrence of HCC. • Deep learning nomogram outperformed the conventional clinical nomogram in predicting early recurrence.
Collapse
Affiliation(s)
- Meng Yan
- Department of Radiology, The First Affiliated Hospital of Jinan University, No. 613, Huangpu West Road, Tianhe District, Guangzhou, 510627, Guangdong, People's Republic of China
| | - Xiao Zhang
- Department of Radiology, The First Affiliated Hospital of Jinan University, No. 613, Huangpu West Road, Tianhe District, Guangzhou, 510627, Guangdong, People's Republic of China
- Neusoft Research of Intelligent Healthcare Technology, Co. Ltd., Artificial Intelligence and Clinical Innovation Research, Guangzhou, 510000, Guangdong, People's Republic of China
| | - Bin Zhang
- Department of Radiology, The First Affiliated Hospital of Jinan University, No. 613, Huangpu West Road, Tianhe District, Guangzhou, 510627, Guangdong, People's Republic of China
| | - Zhijun Geng
- Department of Medical Imaging, Sun Yat-Sen University Cancer Center, No. 651, Dongfeng East Road, Yuexiu District, Guangzhou, 510060, People's Republic of China
| | - Chuanmiao Xie
- Department of Medical Imaging, Sun Yat-Sen University Cancer Center, No. 651, Dongfeng East Road, Yuexiu District, Guangzhou, 510060, People's Republic of China
| | - Wei Yang
- Guangdong Provincial Key Laboratory of Medical Image Processing, School of Biomedical Engineering, Southern Medical University, No. 1023, Shatai Road, Baiyun District, Guangzhou, 510515, Guangdong, People's Republic of China
| | - Shuixing Zhang
- Department of Radiology, The First Affiliated Hospital of Jinan University, No. 613, Huangpu West Road, Tianhe District, Guangzhou, 510627, Guangdong, People's Republic of China
| | - Zhendong Qi
- Department of Radiology, Zhujiang Hospital, Southern Medical University, No. 253, Industrial Road, Haizhu District, Guangzhou, 510282, People's Republic of China
| | - Ting Lin
- Department of Radiology, Zhujiang Hospital, Southern Medical University, No. 253, Industrial Road, Haizhu District, Guangzhou, 510282, People's Republic of China
| | - Qiying Ke
- Medical Imaging Center, the First Affiliated Hospital of Guangzhou University of Chinese Medicine, No. 16, Airport Road, Baiyun District, Guangzhou, 510405, Guangdong, People's Republic of China
| | - Xinming Li
- Department of Radiology, Zhujiang Hospital, Southern Medical University, No. 253, Industrial Road, Haizhu District, Guangzhou, 510282, People's Republic of China.
| | - Shutong Wang
- Department of Liver Surgery, The First Affiliated Hospital of Sun Yat-Sen University, No. 58, Zhong Shan Road 2, Yuexiu District, Guangzhou, 510080, Guangdong, People's Republic of China.
| | - Xianyue Quan
- Department of Radiology, Zhujiang Hospital, Southern Medical University, No. 253, Industrial Road, Haizhu District, Guangzhou, 510282, People's Republic of China.
| |
Collapse
|
4
|
Grut H, Line PD, Syversveen T, Dueland S. Metabolic tumor volume predicts long-term survival after transplantation for unresectable colorectal liver metastases: 15 years of experience from the SECA study. Ann Nucl Med 2022; 36:1073-1081. [PMID: 36241941 PMCID: PMC9668778 DOI: 10.1007/s12149-022-01796-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 10/05/2022] [Indexed: 11/25/2022]
Abstract
Objective To report 15 years of experience with metabolic tumor volume (MTV) of liver metastases from the preoperative 18F-FDG PET/CT to predict long-term survival after liver transplantation (LT) for unresectable colorectal liver metastases (CRLM). Methods The preoperative 18F-FDG PET/CT from all SECA 1 and 2 patients was evaluated. MTV was obtained from all liver metastases. The patients were divided into one group with low MTV (< 70 cm3) and one group with high MTV (> 70 cm3) based on a receiver operating characteristic analysis. Overall survival (OS), disease-free survival (DFS) and post recurrence survival (PRS) for patients with low versus high MTV were compared using the Kaplan–Meier method and log rank test. Clinopathological features between the two groups were compared by a nonparametric Mann–Whitney U test for continuous and Fishers exact test for categorical data. Results At total of 40 patients were included. Patients with low MTV had significantly longer OS (p < 0.001), DFS (p < 0.001) and PRS (p = 0.006) compared to patients with high values. The patients with high MTV had higher CEA levels, number of liver metastases, size of the largest liver metastasis, N-stage, number of chemotherapy lines and more frequently progression of disease at LT compared to the patients with low MTV. Conclusion MTV of liver metastases is highly predictive of long-term OS, DFS and PRS after LT for unresectable CRLM and should be implemented in risk stratification prior to LT.
Collapse
Affiliation(s)
- Harald Grut
- Department of Radiology, Vestre Viken Hospital Trust, 3004, Drammen, Norway.
| | - Pål-Dag Line
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
| | - Trygve Syversveen
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Svein Dueland
- Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
| |
Collapse
|
5
|
Wang F, Chen Q, Zhang Y, Chen Y, Zhu Y, Zhou W, Liang X, Yang Y, Hu H. CT-Based Radiomics for the Recurrence Prediction of Hepatocellular Carcinoma After Surgical Resection. J Hepatocell Carcinoma 2022; 9:453-465. [PMID: 35646748 PMCID: PMC9139347 DOI: 10.2147/jhc.s362772] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 05/09/2022] [Indexed: 01/27/2023] Open
Abstract
Purpose To explore the effectiveness of radiomics signature in predicting the recurrence of hepatocellular carcinoma (HCC) and the benefit of postoperative adjuvant transcatheter arterial chemoembolization (PA-TACE). Patients and Methods In this multicenter retrospective study, 364 consecutive patients with multi-phase computed tomography (CT) images were included. Recurrence-related radiomics features of intra- and peritumoral regions were extracted from the pre-contrast, arterial and portal venous phase, respectively. The radiomics model was established in the training cohort (n = 187) using random survival forests analysis to output prediction probability as “Rad-score” and validated by the internal (n = 92) and external validation cohorts (n = 85). Besides, the Clinical nomogram was developed by clinical-radiologic-pathologic characteristics, and the Combined nomogram was further constructed to evaluate the added value of the Rad-score for individualized recurrence-free survival (RFS) prediction, which is our primary and only endpoint. The performance of the three models was assessed by the concordance index (C-index). Furthermore, all the patients were stratified into high- and low-risk groups of recurrence by the median value of the Rad-score to analyze the benefit of PA-TACE. Results The model built using radiomics signature demonstrated favorable prediction of HCC recurrence across all datasets, with C-index of 0.892, 0.812, 0.809, separately in the training, the internal and external validation cohorts. Univariate and multivariate analysis revealed that the Rad-score was an independent prognostic factor. Significant differences were found between the high- and low-risk group in RFS prediction in all three cohorts. Further analysis showed that compared with the low-risk group, patients with the high-risk received more benefits from PA-TACE. Conclusion The newly developed Rad-score was not only a powerful biomarker in predicting the RFS of HCC but also a strong stratification basis to explore the high-risk patients who could benefit from PA-TACE.
Collapse
Affiliation(s)
- Fang Wang
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, 310016, People’s Republic of China
| | - Qingqing Chen
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, 310016, People’s Republic of China
| | - Yuanyuan Zhang
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, 310016, People’s Republic of China
- Medical College, Shaoxing University, Shaoxing, 312000, People’s Republic of China
| | - Yinan Chen
- SenseTime Research, Shanghai, 200030, People’s Republic of China
| | - Yajing Zhu
- SenseTime Research, Shanghai, 200030, People’s Republic of China
| | - Wei Zhou
- Department of Radiology, Huzhou Central Hospital, Affiliated to Huzhou University, Huzhou, 313000, People’s Republic of China
| | - Xiao Liang
- Department of General Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, 310016, People’s Republic of China
| | - Yunjun Yang
- Department of Radiology, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, People’s Republic of China
- Yunjun Yang, Department of Radiology, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, People’s Republic of China, Email
| | - Hongjie Hu
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, 310016, People’s Republic of China
- Correspondence: Hongjie Hu, Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, 310016, People’s Republic of China, Tel/Fax +86-0571-86044817, Email
| |
Collapse
|
6
|
Kang S, Kim JD, Choi DL, Choi B. Predicting the Recurrence of Hepatocellular Carcinoma after Primary Living Donor Liver Transplantation Using Metabolic Parameters Obtained from 18F-FDG PET/CT. J Clin Med 2022; 11:jcm11020354. [PMID: 35054048 PMCID: PMC8778128 DOI: 10.3390/jcm11020354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/07/2022] [Accepted: 01/10/2022] [Indexed: 11/26/2022] Open
Abstract
This study evaluated the prognostic value of metabolic parameters based on the standardized uptake value (SUV) normalized by total body weight (bwSUV) and by lean body mass (SUL) measured on 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) for predicting tumor recurrence after primary living donor liver transplantation (LDLT) in patients with hepatocellular carcinoma (HCC) without transplantation locoregional therapy. This retrospective study enrolled 49 patients with HCC. The maximum tumor bwSUV (T-bwSUVmax) and SUL (T-SULmax) were measured on PET. The maximum bwSUV (L-bwSUVmax), mean bwSUV (L-bwSUVmean), maximum SUL (L-SULmax), and mean SUL (L-SULmean) were measured in the liver. All metabolic parameters were evaluated using survival analyses and compared to clinicopathological factors. Tumor recurrence occurred in 16/49 patients. Kaplan–Meier analysis revealed that all metabolic parameters were significant (p < 0.05). Univariate analysis revealed that prothrombin-induced by vitamin K absence or antagonist-II; T-stage; tumor number; tumor size; microvascular invasion; the Milan criteria, University of California, San Francisco (UCSF), and up-to-seven criteria; T-bwSUVmax/L-bwSUVmean; T-SULmax; T-SULmax/L-SULmax; and T-SULmax/L-SULmean were significant predictors. Multivariate analysis revealed that the T-SULmax/L-SULmean (hazard ratio = 115.6; p = 0.001; cut-off, 1.81) and UCSF criteria (hazard ratio = 172.1; p = 0.010) were independent predictors of tumor recurrence. SUL-based metabolic parameters, especially T-SULmax/L-SULmean, were significant, independent predictors of HCC recurrence post-LDLT.
Collapse
Affiliation(s)
- Sungmin Kang
- Department of Nuclear Medicine, Daegu Catholic University Medical Center, Daegu Catholic University School of Medicine, 33, Duryugongwon-ro 17-gil, Nam-gu, Daegu 42472, Korea;
| | - Joo Dong Kim
- Division of Hepatobiliary Pancreas Surgery and Abdominal Organ Transplantation, Department of Surgery, Daegu Catholic University Medical Center, Daegu Catholic University School of Medicine, 33, Duryugongwon-ro 17-gil, Nam-gu, Daegu 42472, Korea; (J.D.K.); (D.L.C.)
| | - Dong Lak Choi
- Division of Hepatobiliary Pancreas Surgery and Abdominal Organ Transplantation, Department of Surgery, Daegu Catholic University Medical Center, Daegu Catholic University School of Medicine, 33, Duryugongwon-ro 17-gil, Nam-gu, Daegu 42472, Korea; (J.D.K.); (D.L.C.)
| | - Byungwook Choi
- Department of Nuclear Medicine, Daegu Catholic University Medical Center, Daegu Catholic University School of Medicine, 33, Duryugongwon-ro 17-gil, Nam-gu, Daegu 42472, Korea;
- Correspondence: ; Tel.: +82-53-650-4789
| |
Collapse
|