MRI影像组学对135例肝癌耐药蛋白PFKFB3的预测价值

Value of enhanced MRI radiomics in predicting the drug-resistant protein PFKFB3 in 135 cases of hepatocellular carcinoma

目的探讨原发性肝细胞肝癌(HCC)MRI强化特点、影像组学特征与癌组织中PFKFB3表达的相关性,建立HCC耐药相关蛋白的影像组学预测模型。方法回顾性分析2015年1月至2020年12月接受手术治疗并行术前增强MRI HCC患者135例,统计患者的临床数据(年龄、性别、吸烟史、饮酒史、丙氨酸氨基转移酶、天冬氨酸氨基转移酶、甲胎蛋白、病理分级、乙型肝炎病毒感染)、传统影像学指标(肿瘤大小、包膜、动脉期强化特征、肿瘤坏死、门静脉侵犯、肿瘤供血类型、出血、肝内卫星灶、动脉期肿瘤-肝差异)及影像组学特征,并通过免疫组织化学法检测PFKFB3表达。二元Logistic分析筛选出独立预测因素(P<0.05),根据筛选后的训练集特征构建影像组学预测模型。利用受试者工作特征(ROC)曲线评估预测模型的准确性并在验证集中进行验证。结果HCC患者丙氨酸氨基转移酶(OR=0.36,95%CI:0.16~0.83,P=0.017)及肝内卫星灶(OR=6.89,95%CI:1.76~27.03,P=0.006)是PFKFB3阳性表达的独立预测因子,MRI影像组学模型训练集AUC值为0.99,在验证集AUC值为0.80、95%CI为0.61~1.00、灵敏度为0.78、特异度为0.75。结论增强MRI影像组学预测模型可一定程度预测原发性HCC中PFKFB3的表达,可为HCC治疗肿瘤耐药提供重要的信息。

Objective To investigate the correlation between MRI enhancement features,radiomics characteristics and PFKFB3 expression in primary hepatocellular carcinoma(HCC)tissue,and to establish a radiomics prediction model for drug-resistant related proteins of HCC.Methods Information of 135 HCC patients who received preoperative multiphase MRI and surgical resection during Jan.2015 and Dec.2020 was retrospectively analyzed.The clinical data(age,gender,history of smoking and drinking,alanine aminotransferase,aspartate transaminase,alpha-fetoprotein,pathologic stage and hepatitis B infection),conventional imaging features(tumor size,capsular,enhancement characteristics in arterial phase,necrosis,portal vein invasion,blood-supply type,hemorrhage,intrahepatic satellite foci and arterial tumor-liver differences in arterial phase),and radiomic features were recorded.The expression of PFKFB3 was detected with immunohistochemistry.The independent predictors were screened with multivariate analysis(P<0.05).The radiomics prediction model was constructed based on the features of the selected training set.The receiver operating characteristic(ROC)curve was drawn.The accuracy of the prediction model was evaluated with the area under the curve(AUC)and verified in the validation set.Results Alanine aminotransferase(OR=0.36,95%CI:0.16-0.83,P=0.017)and the presence of intrahepatic satellite foci(OR=6.89,95%CI:1.76-27.03,P=0.006)were independent predictors of positive PFKFB3 expression.The AUC of the MRI radiomics model was 0.99 in the training set and 0.80 in the validation set,with 95%CI of 0.61-1.00,sensitivity of 0.78 and specificity of 0.75.Conclusion The model of enhanced MRI radiomics can predict the expression of PFKFB3 in primary HCC,which can provide important information of tumor drug resistance in the treatment of HCC.