Abstract
ObjectiveTo investigate the value of whole-lesion texture analysis on preoperative gadoxetic acid enhanced magnetic resonance imaging (MRI) for predicting tumor Ki-67 status after curative resection in patients with hepatocellular carcinoma (HCC).MethodsThis study consisted of 89 consecutive patients with surgically confirmed HCC. Texture features were extracted from multiparametric MRI based on whole-lesion regions of interest. The Ki-67 status was immunohistochemical determined and classified into low Ki-67 (labeling index ≤15%) and high Ki-67 (labeling index >15%) groups. Least absolute shrinkage and selection operator (LASSO) and multivariate logistic regression were applied for generating the texture signature, clinical nomogram and combined nomogram. The discrimination power, calibration and clinical usefulness of the three models were evaluated accordingly. Recurrence-free survival (RFS) rates after curative hepatectomy were also compared between groups.ResultsA total of 13 texture features were selected to construct a texture signature for predicting Ki-67 status in HCC patients (C-index: 0.878, 95% confidence interval: 0.791−0.937). After incorporating texture signature to the clinical nomogram which included significant clinical variates (AFP, BCLC-stage, capsule integrity, tumor margin, enhancing capsule), the combined nomogram showed higher discrimination ability (C-index: 0.936vs. 0.795, P<0.001), good calibration (P>0.05 in Hosmer-Lemeshow test) and higher clinical usefulness by decision curve analysis. RFS rate was significantly lower in the high Ki-67 group compared with the low Ki-67 group after curative surgery (63.27%vs. 85.00%, P<0.05). ConclusionsTexture analysis on gadoxetic acid enhanced MRI can serve as a noninvasive approach to preoperatively predict Ki-67 status of HCC after curative resection. The combination of texture signature and clinical factors demonstrated the potential to further improve the prediction performance.
Highlights
Hepatocellular carcinoma (HCC) is one of the most lethal cancers with increasing mortality worldwide [1,2]
Hepatectomy is recommended as the mainstream curative therapy for HCC patients with well-preserved liver function, the high early recurrence rate and poor prognosis after hepatic resection remains a major concern in treatment [3,4]
In HCC patients, high levels of Ki-67 can be indicative of tumor aggressiveness, such as advanced tumor stages, portal vein invasion and intra-hepatic metastasis [10], which is associated with high early recurrence rate and poor prognosis [11,12,13]
Summary
Hepatocellular carcinoma (HCC) is one of the most lethal cancers with increasing mortality worldwide [1,2]. Hepatectomy is recommended as the mainstream curative therapy for HCC patients with well-preserved liver function, the high early recurrence rate and poor prognosis after hepatic resection remains a major concern in treatment [3,4]. Cell proliferation status is an important factor that reflects tumor biology and affects prognosis and treatment efficacy [5]. In HCC patients, high levels of Ki-67 can be indicative of tumor aggressiveness, such as advanced tumor stages, portal vein invasion and intra-hepatic metastasis [10], which is associated with high early recurrence rate and poor prognosis [11,12,13]. Ki-67 has been proposed as an independent prognostic factor for surgically resected HCC in recent studies [5,14]. A preoperative noninvasive way to predict Ki-67 status is needed to guide individualized HCC treatment and postoperative surveillance in clinical practices
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