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Preoperative Prediction of Glypican-3 Expression in Hepatocellular Carcinoma Using Sonazoid Contrast-Enhanced
Shangman Yang1,2, Zerong Huang1, Wei Zheng1
1Department of Ultrasound, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, People's Republic of China.
Objective:
To develop and validate a noninvasive radiomics approach based on Sonazoid contrast-enhanced ultrasound (CEUS) for preoperative prediction of Glypican-3 (GPC3) status in solitary hepatocellular carcinoma (HCC) patients and to evaluate its association with early recurrence-free survival (RFS).
Materials And Methods:
This diagnostic accuracy study retrospectively included 278 solitary HCC patients at a grade A Tertiary Hospital (2020.3-2024.1). Radiomics features were extracted from CEUS images, and robust feature selection was performed using minimum redundancy-maximum relevance (mRMR) and least absolute shrinkage and selection operator (LASSO). A logistic-regression radiomics model was trained and internally validated using a pathologic reference standard. A hybrid model combining the radiomics signature with significant clinical variables was then constructed. Model performance was assessed by the area under the receiver operating characteristic curve (AUC). RFS was compared using the log‑rank test.
Results:
Among 278 patients (median age, 57 years; IQR, 49-64 years; 232 males), alpha-fetoprotein (AFP) > 200 ng/mL and the radiomics score were independent predictors of GPC3 positivity. The hybrid model integrating CEUS-based radiomics features and AFP achieved AUCs of 0.81 (95% CI: 0.74-0.89) and 0.78 (95% CI: 0.66-0.89) in the training and validation sets, respectively, significantly outperforming the radiomics model (AUC 0.74 (95% CI: 0.65-0.83) and 0.67 (95% CI: 0.52-0.83), both p < 0.01). The radiomics score was not significantly associated with early RFS (p > 0.05).
Conclusion:
A hybrid model integrating CEUS-based radiomics features and AFP, developed in solitary HCC, shows potential for non-invasive preoperative prediction of GPC3 positive expression in HCC, which may facilitate personalized preoperative treatment planning for these patients. However, it did not predict early recurrence-free survival, and its prognostic value was not demonstrated in this study.
