Abstract
BackgroundIntrahepatic cholangiocarcinoma (ICC) is a highly aggressive malignant tumor with a poor prognosis. This study aimed to establish a novel clinical-radiomics model for predicting the prognosis of ICC after radical hepatectomy.MethodsA clinical-radiomics model was established for 82 cases of ICC treated with radical hepatectomy in our hospital from May 2011 to December 2020. Radiomics features were extracted from venous-phase and arterial-phase images of computed tomography. Kaplan-Meier survival analysis was generated to compare overall survival (OS) between different groups. The independent factors were identified by univariate and multivariate Cox regression analyses. Nomogram performance was evaluated regarding discrimination, calibration, and clinical utility. C-index and area under the curve (AUC) were utilized to compare the predictive performance between the clinical-radiomics model and conventional staging systems.ResultsThe radiomics model included five features. The AUC of the radiomics model was 0.817 in the training cohort, and 0.684 in the validation cohort. The clinical-radiomics model included psoas muscle index, radiomics score, hepatolithiasis, carcinoembryonic antigen, and neutrophil/lymphocyte ratio. The reliable C-index of the model was 0.768, which was higher than that of other models. The AUC of the model for predicting OS at 1, and 3 years was 0.809 and 0.886, which was significantly higher than that of the American Joint Committee on Cancer 8th staging system (0.594 and 0.619), radiomics model (0.743 and 0.770), and tumor differentiation (0.645 and 0.628). After stratification according to the constructed model, the median OS was 59.8 months for low-risk ICC patients and 10.1 months for high-risk patients (p < 0.0001).ConclusionThe clinical-radiomics model integrating sarcopenia, clinical features, and radiomics score was accurate for prognostic prediction for mass-forming ICC patients. It provided an individualized prognostic evaluation in patients with mass-forming ICC and could helped surgeons with clinical decision-making.
Highlights
Intrahepatic cholangiocarcinoma (ICC) is a malignant tumor, which accounts for 10-15% of primary liver cancer [1]
We established a clinical-radiomics model based on radiomics and sarcopenia to predict the prognosis of patients with mass-forming ICC who underwent curative resection
Compared with conventional staging systems, this model showed better performance, which indicated the utility of the model for predicting prognosis in ICC patients
Summary
Intrahepatic cholangiocarcinoma (ICC) is a malignant tumor, which accounts for 10-15% of primary liver cancer [1]. ICC has a poor prognosis due to its insidious onset, high aggressiveness, and lack of effective treatment [5]. Radical hepatectomy is the only effective treatment for ICC [6], but it is still easy to relapse and metastasize, and the expected 5-year overall survival (OS) rate of postoperative patients is 25-40% [5,6,7,8]. ICC patients have a dismal postoperative prognosis; it is crucial to identify the prognostic factors for ICC that could help surgeons make personalized precision treatment. Intrahepatic cholangiocarcinoma (ICC) is a highly aggressive malignant tumor with a poor prognosis. This study aimed to establish a novel clinical-radiomics model for predicting the prognosis of ICC after radical hepatectomy
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