Combining radiomics and imaging biomarkers with clinical variables for the prediction of HCC recurrence after liver transplantation.

Abstract

Background & aims: To develop and validate an integrated model that combines CT-based radiomics and imaging biomarkers with clinical variables to predict recurrence and recurrence-free survival (RFS) in patients with HCC following liver transplantation (LT).

Methods: This two-center retrospective study includes 123 patients with HCC who underwent LT between 2007 and 2021. Radiomic features (RF) were extracted from baseline CT liver tumor volume. Feature selection was performed using the Least absolute shrinkage and selection operator (LASSO) regression method with 10-fold cross-validation in the training cohort (n=48) to build a predictive radiomics signature for HCC recurrence. Combined diagnostic models were built based on the radiomics signature supplemented with imaging features beyond the Milan criteria, the AFP model and Metroticket 2.0 before LT using multivariate logistic regression. ROC analyses were performed in both internal (n=22) and external (n=53) validation cohorts and patients were stratified into either high- or low-risk group for HCC recurrence. Kaplan-Meier analysis was performed to analyze RFS.

Results: LASSO and multivariate regression analysis revealed four independent predictors associated with an increased risk of HCC recurrence: radiomics signature of five RF, peritumoral enhancement, satellite nodules and no bridging therapies. For prediction of tumor recurrence, the highest AUC of the final integrated models combining clinical variables, non-radiomics imaging features and radiomics was 0.990 and 0.900 for the internal and external validation sets, respectively, outperforming the Milan and clinical stand-alone models. In all integrated models, the high-risk groups had a shorter RFS than the corresponding low-risk group.

Conclusions: CT-based radiomics and imaging parameters beyond the Milan criteria representing aggressive behavior, along with history of bridging therapies, show potential for predicting HCC recurrence after LT.