Abstract
PurposeTo describe the clinical characteristics and outcomes of patients with dual-phenotype hepatocellular carcinoma (DPHCC) and investigate the use of radiomics to establish an image-based signature for preoperative differential diagnosis.MethodsThis study included 50 patients with a postoperative pathological diagnosis of DPHCC (observation group) and 50 patients with CK7- and CK19-negative HCC (control group) who attended our hospital between January 2015 and December 2018. All patients underwent Gd-EOB-DTPA-enhanced MRI within 1 month before surgery. Arterial phase (AP), portal venous phase (PVP), delayed phase (DP) and hepatobiliary phase (HBP) images were transferred into a radiomics platform. Volumes of interest covered the whole tumor. The dimensionality of the radiomics features were reduced using LASSO. Four classifiers, including multi-layer perceptron (MLP), support vector machines (SVM), logistic regression (LR) and K-nearest neighbor (KNN) were used to distinguish DPHCC from CK7- and CK19-negative HCC. Kaplan–Meier survival analysis was used to assess 1-year disease-free survival (DFS) and overall survival (OS) in the observation and control groups.ResultsThe best preoperative diagnostic power for DPHCC will likely be derived from a combination of different phases and classifiers. The sensitivity, specificity and accuracy of LR in PVP (0.740, 0.780, 0.766), DP (0.893, 0.700, 0.798), HBP (0.800, 0.720, 0.756) and MLP in PVP (0.880, 0.720, 0.798) were better performance. The 1-year DFS and OS of the patients in the observation group were 69% and 78%, respectively. The 1-year DFS and OS of the patients in the control group were 83% and 85%, respectively. Kaplan–Meier survival analysis showed no statistical difference in DFS and OS between groups (P = 0.231 and 0.326), but DFS and OS were numerically lower in patients with DPHCC.ConclusionThe radiomics features extracted from Gd-EOB-DTPA-enhanced MR images can be used to diagnose preoperative DPHCC. DPHCC is more likely to recur and cause death than HCC, suggesting that active postoperative management of patients with DPHCC is required.
Highlights
Hepatocellular carcinoma (HCC) is among the most common malignancies and the third leading cause of cancerrelated death worldwide (Torre et al 2015)
The morphology of dual-phenotype hepatocellular carcinoma (DPHCC) is similar to HCC, but DPHCC simultaneously shows the expression of markers of HCC and cholangiocellular carcinoma (CK7, CK19) in immunohistochemistry
A preliminary diagnosis of DPHCC on preoperative imaging is essential for clinical decision-making, as evidence suggests that CK19-positive HCC has high invasive, proliferative and migration abilities (Lee et al 2012, 2013)
Summary
Hepatocellular carcinoma (HCC) is among the most common malignancies and the third leading cause of cancerrelated death worldwide (Torre et al 2015). As a subtype of HCC, dual-phenotype hepatocellular carcinoma (DPHCC) is included in the evidence-based practice guidelines for pathological diagnosis of primary liver cancer in China (2015 update) (Chinese Society of Liver Cancer et al 2015). A preliminary diagnosis of DPHCC on preoperative imaging is essential for clinical decision-making, as evidence suggests that CK19-positive HCC has high invasive, proliferative and migration abilities (Lee et al 2012, 2013). Gao et al performed preoperative pathological grading prediction of hepatocellular carcinoma based on MRI radiomics (Gao et al 2019). The objective of this study was to describe the clinical characteristics and outcomes of patients with DPHCC and investigate the use of radiomics to establish an image-based signature for use in preoperative differential diagnosis
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