Discussion
tumor, unresectable HCC, SD, PD, HCC, ALBI
REGRESSION, TUMOR
The current study evaluated the potential value of MRI-based radiomics combined with ALBI score in the prediction of the therapeutic response to HAIC in patients with unresectable HCC. We proved that intratumoral radiomics from pretherapeutic MRI imaging could improve the performance of clinical features in the prediction of therapeutic response. The combined model achieved an optimal predictive efficiency in patients with unresectable HCC. A nomogram combining radiomics features and ALBI score could efficiently separate those with SD + PD response from those with PR response in both training and validation cohorts. Meanwhile, the survival analysis also demonstrate that the patients with high-risk to non-response had significantly shorter PFS than the low-risk patients in the combined model. To the best of our knowledge, among all the related radiomics studies for HCC, our study was the first to establish a nomogram from the combined model to predict therapeutic response to HAIC in patients with HCC.HAIC has been regarded as an effective treatment for advanced HCC in Asia. In several studies, HAIC responders have been proven to have longer survival rates than HAIC non-responders; thus, performing HAIC before administering molecular targeted therapy is recommended. Clinical features and tumor markers were used to predict the therapeutic response to HAIC in most of the previous studies; one of which reported that the early change of tumor markers and the imaging assessment 2 weeks after HAIC treatment were useful in predicting therapeutic response and prognosis (Miyaki et al. In our study, a nomogram combined with MRI radiomics and ALBI score showed remarkable differences between PR and SD + PD groups. Furthermore, radiomics score was identified by the univariate and multivariate logistic regression models as an independent predictor of non-response. In a previous study, VWF:Ag/ADAMTS13:AC ratio was used as a biomarker of treatment response in HCC patients before the initiation of HAIC treatment, and ROC curves were used to evaluate predictive efficiency, yielding an AUC of 0.715 (Takaya et al. Currently, clinical MR scans are routinely acquired for diagnosis and staging in HCC. These MRI images contain important information about tumor heterogeneity, including biological characteristics determined by underlying micro-level components of the tumor tissue (Gillies et al. In previous studies of HCC, radiomics obtained from pretreatment CT was thought to be a good predictor of the HCC treatment response after TACE, which could prevent unnecessary treatment (Park et al. In recent years, The ALBI score, a scoring system based solely on serum levels of albumin and total bilirubin, has been proposed as a simple and objective model to assess the liver reserve function in patients with HCC (Johnson et al. This study has several limitations. First, selection bias might exist because of the retrospective design in our study. Second, although our cohort remains one of the largest in terms of radiomics features and interventional treatment of HCC, the patients were enrolled from a single institution with limited sample size, so the conclusions need to be verified by further prospective studies. Third, our study conducted image segmentation manually; an automated method for image segmentation may provide greater stability (de Hoop et al. 