Abstract
BackgroundPartial hepatectomy is the first option for intrahepatic mass-forming cholangiocarcinoma (IMCC) treatment, which would prolong survival. The main reason for the poor outcome after curative resection is the high incidence of early recurrence (ER). The aim of this study was to investigate the combined predictive performance of qualitative and quantitative magnetic resonance imaging (MRI) features and prognostic immunohistochemical markers for the ER of IMCC.MethodsForty-seven patients with pathologically proven IMCC were enrolled in this retrospective study. Preoperative contrast-enhanced MRI and post-operative immunohistochemical staining of epidermal growth factor receptors (EGFR), vascular endothelial growth factor receptor (VEGFR), P53 and Ki67 were performed. Univariate analysis identified clinic-radiologic and pathological risk factors of ER. Radiomics analysis was performed based on four MRI sequences including fat suppression T2-weighted imaging (T2WI/FS), arterial phase (AP), portal venous phase (PVP), and delayed phase (DP) contrast enhanced imaging. A clinicoradiologic-pathological (CRP) model, radiomics model, and combined model were developed. And ROC curves were used to explore their predictive performance for ER stratification.ResultsEnhancement patterns and VEGFR showed significant differences between the ER group and non-ER group (P = 0.001 and 0.034, respectively). The radiomics model based on AP, PVP and DP images presented superior AUC (0.889, 95% confidence interval (CI): 0.783–0.996) among seven radiomics models with a sensitivity of 0.938 and specificity of 0.839. The combined model, containing enhancement patterns, VEGFR and radiomics features, showed a preferable ER predictive performance compared to the radiomics model or CRP model alone, with AUC, sensitivity and specificity of 0.949, 0.875 and 0.774, respectively.ConclusionsThe combined model was the superior predictive model of ER. Combining qualitative and quantitative MRI features and VEGFR enables ER prediction, thus facilitating personalized treatment for patients with IMCC.
Highlights
Partial hepatectomy is the first option for intrahepatic mass-forming cholangiocarcinoma (IMCC) treatment, which would prolong survival
The study population was selected using the following inclusion criteria: (a) patients who underwent preoperative liver contrast enhanced magnetic resonance imaging (MRI) (CE-MRI) within 4 weeks of their surgery, (b) patients without a history of previous adjuvant treatment before the surgery, (c) patients with histopathologically proven IMCC and negative resection margin (R0), combined hepatocellular-cholangiocarcinoma were excluded, (d) patients without a history of other tumors, and (e) patients who completed at least 2 years of follow-up
Among 33 IMCC patients with gradual enhancement pattern, 26 (78.8%) patients were in the early recurrence (ER) group, while all 5 (100%) patients with wash in and wash out enhancement pattern were in non-ER group (P = 0.002)
Summary
Partial hepatectomy is the first option for intrahepatic mass-forming cholangiocarcinoma (IMCC) treatment, which would prolong survival. The main reason for the poor outcome after curative resection is the high incidence of early recurrence (ER). Intrahepatic cholangiocarcinoma (ICC) is the second most common primary liver malignancy and is arising in incidence worldwide [1, 2]. It originates from the intrahepatic biliary epithelium and can be classified into three types according to the morphologic classification system: mass forming, periductal infiltrating, and intraductal growing [3]. Partial hepatectomy is the first option for IMCC curative treatment, which would prolong survival [4]. The main reason for the poor outcome is the incidence of recurrence, which can be as high as 54–71% [5, 7, 8]
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