MRI-Based Quantification of Intratumoral Heterogeneity Predicts Response in Hepatocellular Carcinoma Treated with
Hai-Tao Yan1, Qing-Quan Zu1, Hong-Jin Hua2
1Department of Interventional Radiology, The First Affiliated Hospital with Nanjing Medical University, Nanjing 210029, China (H.T.Y., Q.Q.Z., S.L., H.B.S., J.X.Z.).
Rationale And Objectives:
Hepatocellular carcinoma (HCC) is highly heterogeneous, resulting in different treatment responses to anti-tumor therapy. The present study aimed to investigate the prognostic value of noninvasive MRI-based intratumoral heterogeneity (ITH) quantification for predicting treatment response to atezolizumab-bevacizumab combined with transarterial chemoembolization (TACE) /hepatic artery infusion chemotherapy (HAIC) in unresectable HCC.
Materials And Methods:
Patients with unresectable HCC (n=151) who received atezolizumab-bevacizumab combined with TACE/HAIC at multiple centers were enrolled between January 2019 and January 2024. Conventional and habitat radiomic features were extracted from MRI to construct the ITH score. Predictive models based on clinical variables, radiomic features, and the ITH score were developed and evaluated using the area under the receiver operating characteristic curve (AUC).
Results:
88 patients (58.3%) showed a response to atezolizumab-bevacizumab combined with TACE/HAIC. The combined model integrating clinical variables, radiomic features, and the ITH score achieved the highest accuracy in predicting treatment response to triple therapy with an AUC of 0.971, 0.937, and 0.868 in the training, validation, and testing cohort, respectively. Furthermore, the combined model can categorize patients into high-risk and low-risk groups for progression-free survival (PFS) and overall survival (OS) in the training (p < 0.001 for PFS and OS), validation (p < 0.001 for PFS and OS) and testing cohort (p = 0.005 for PFS; p < 0.001 for OS).
Conclusion:
The MRI-based ITH score, when combined with clinical and radiomic features, provides a robust predictive tool for treatment response in HCC patients undergoing atezolizumab-bevacizumab combined with TACE/HAIC.
Data Availability Statement:
The datasets generated or analyzed during the study are available from the corresponding author on reasonable request.
