Diffusion-weighted imaging (DWI)-based radiomic signature could successfully predict prognosis in patients with intrahepatic cholangiocarcinoma (CCA) and further suggest which patients could benefit from postoperative adjuvant chemotherapy, according to a new study published in Insights into Imaging.

The study conducted by Yang et al included 124 patients previously diagnosed with intrahepatic CCA and were posteriorly divided into a training group and a validation group. A clinicopathological-radiographic (CPR) model was crafted as a reference to validate the results from the radiomic signature. Early recurrence was defined as the presence of the tumor within 1 year after surgery.

Similar results were obtained for predicting early recurrence in both the radiomic signature and the CPR model, and a further improvement was achieved when integrating the radiomic signature with clinicopathological and radiographic items. This tool also correctly stratified patients according to survival outcomes, considering their risk of early recurrence into disease-free survival or overall survival.


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Adjuvant chemotherapy was initiated in all patients, and an improved prognosis was noted in high-risk patients previously classified as such by the radiomic signature, while the low-risk group experienced a lower chemotherapy efficacy. 

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Further treatment options should be studied when considering a disease with such high mortality, currently displaying only 35% of postoperative survival at its best, the authors said. Adjuvant chemotherapy was therefore recommended. Nonetheless, not all patients seemed to benefit from this approach, and considering the important side effects of this treatment, a better selection of patients must be made.

“Predicting biomarkers or models to personalize risk-benefit evaluation of chemotherapy will improve patient outcomes and avoid unnecessary toxicities and economic burdens for patients with non-chemotherapy benefits,” the authors concluded.

“The development of fast segmentation tool and easy-to-use software interface will facilitate the application of radiomic signature in prognostic assessment and clinical decisions in the future.”

Reference

Yang Y, Zou X, Zhou W, et al. DWI-based radiomic signature: potential role for individualized adjuvant chemotherapy in intrahepatic cholangiocarcinoma after partial hepatectomy. Insights Imaging. Published online March 4, 2022. doi:10.1186/s13244-022-01179-7