Development and validation of a pyradiomics signature to predict initial treatment response and prognosis during transarterial chemoembolization in hepatocellular carcinoma

We aimed to develop and validate a pyradiomics model for preoperative prediction of initial treatment response to transarterial chemoembolization (TACE) in patients with hepatocellular carcinoma (HCC). To this end, computed tomography (CT) images were acquired from multi-centers. Numerous pyradiomics features were extracted and machine learning approach was used to build a model for predicting initial response of TACE treatment. The predictive accuracy, overall survival (OS), and progression-free survival (PFS) were analyzed. Gene Set Enrichment Analysis (GSEA) was further used to explore signaling pathways in The Cancer Genome Atlas (TCGA)-HCC cohort. Overall, 24 of the 1,209 pyradiomic features were selected using the least absolute shrinkage and selection operator (LASSO) algorithm. The pyradiomics signature showed high predictive accuracy across the discovery set (AUC: 0.917, 95% confidence interval [CI]: 86.93-96.39), validation set 1 (AUC: 0.902, 95% CI: 84.81-95.59), and validation set 2 (AUC: 0.911; 95% CI: 83.26-98.98). Based on the classification of pyradiomics model, we found that a group with high values base on pyramidomics score showed good PFS and OS (both P<0.001) and was negatively correlated with glycolysis pathway. The proposed pyradiomics signature could accurately predict initial treatment response and prognosis, which may be helpful for clinicians to better screen patients who are likely to benefit from TACE.