Abstract
Objectives To predict the regenerative rate of liver in patients with HCCs after right hepatectomy using texture analysis on preoperative CT combined with clinical features. Materials and Methods 88 patients with 90 HCCs who underwent right hepatectomy were retrospectively included. The future remnant liver was semiautomatically segmented, and the volume of future remnant liver on preoperative CT (LVpre) and the volume of remnant liver on following-up CT (LVfu) were measured. We calculated the regeneration index (RI) by the following equation: (LVfu – LVpre)/LVpre) × 100 (%). The support vector machine recursive method was used for the feature selection. The Naive Bayes classifier was used to predict liver RI, and 5-fold cross-validation was performed to adjust the parameters. Sensitivity, specificity, and accuracy were calculated to evaluate the diagnostic efficiency of the model. Results The mean RI was 142.99 ± 92.17%. Of all clinical parameters and texture features, the AST, ALB, PT-INR, Perc.10%, and S(5, −5)Correlat were found to be statistically significant with RI. The diagnostic sensitivity, specificity, and accuracy of the model in the training group were 0.902, 0.634, and 0.768, and the AUC value of the obtained model was 0.841. In the test group, the sensitivity, specificity, and accuracy of the model were 1.0, 0.429, and 0.778, respectively, and the AUC value was 0.844. Conclusion The use of texture analysis on preoperative CT combined with clinical features can be helpful in predicting the liver regeneration rate in patients with HCCs after right hepatectomy.
Highlights
Hepatocellular carcinoma (HCC) is the fifth most common type of cancer and the second leading cause of cancer-related death worldwide [1]. e treatments of HCC are varied, among which surgical excision is the main method of HCC therapies [2]
88 patients with 90 HCCs who underwent right hepatectomy were included for analysis with 90 lesions, including 79 men (50.76 ± 12.03 years; range 23–78 years) and 9 women (45.78 ± 4.24 years; range 39–52 years). e baseline characteristics including sex, age, alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), gamma-glutamyl transpeptidase (GGT), total protein (TP), albumin (ALB), total bilirubin (TBIL), direct bilirubin (DBIL), hemoglobin, platelet (PLT), and prothrombin time-international normalized ratio (PT-INR) were collected
No statistically significant difference was found between the higher regeneration index (RI) and lower RI group with sex, age, ALT, ALP, GGT, TP, TBIL, DBIL, hemoglobin, and PLT. e LVpre was 367.14 ± 95.61 cm3 versus 541.45 ± 117.52 cm3; the LVfu was 1009.72 ± 176.63 cm3 versus 928.21 ± 204.81 cm3; and the RI was 191.64 ± 90.80% versus 72.72 ± 22.51%
Summary
Hepatocellular carcinoma (HCC) is the fifth most common type of cancer and the second leading cause of cancer-related death worldwide [1]. e treatments of HCC are varied, among which surgical excision is the main method of HCC therapies [2]. The remnant liver tissue after partial hepatectomy has great regenerative potential and even back to its original size [3], posthepatectomy liver failure in patients is still the leading cause of liver excision-related mortality [4, 5], with an incidence of between 1.2% and 32% [6]. Multiple imaging modalities have been explored to measure the volume of remnant liver, including computed tomography (CT), magnetic resonance imaging (MRI), and ultrasound [4, 12] Of these imaging modalities, Contrast Media & Molecular Imaging the volumetric CT plays an important role in evaluating the liver volume as it has good reconstructive ability [13, 14].
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