SpringerLink
Log in

Radiomics-Based Preoperative Prediction of Lymph Node Metastasis in Intrahepatic Cholangiocarcinoma Using Contrast-Enhanced Computed Tomography

  • Hepatobiliary Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Lymph node (LN) metastasis is significantly associated with worse prognosis for patients with intrahepatic cholangiocarcinoma (ICC). Improvement in preoperative assessment on LN metastasis helps in treatment decision-making. We aimed to investigate the role of radiomics-based method in predicting LN metastasis for patients with ICC.

Methods

A total of 296 patients with ICC who underwent curative-intent hepatectomy and lymphadenectomy at two centers in China were analyzed. Radiomic features, including histogram- and wavelet-based features, shape and size features, and texture features were extracted from four-phase computerized tomography (CT) images. The clinical and conventional radiological variables which were independently associated with LN metastasis were also identified. A combined nomogram predicting LN metastasis was developed, and its performance was determined by discrimination, calibration, and stratification of long-term prognosis. The results were validated by the internal and external validation cohorts.

Results

Twenty-four radiomic features were selected into the nomogram. The established nomogram demonstrated good discrimination and calibration, with areas under the curve (AUCs) of 0.98 [95% confidence interval (CI) 0.96–0.99], 0.93 (0.88–0.98), and 0.89 (0.81–0.96) in the training and two validation cohorts, respectively. The 5-year overall survival (OS) and recurrence-free survival (RFS) rates of patients with high risk of LN metastasis as grouped by nomogram were poorer than those of patients with low risk in the training cohort (OS 28.8% versus 53.9%, p < 0.001; RFS 26.3% versus 44.2%, p = 0.001). Similar results were observed in the two validation cohorts.

Conclusions

Radiomics-based method provided accurate prediction of LN metastasis and prognostic assessment for ICC patients, and might aid the preoperative surgical decision.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price includes VAT (United Kingdom)

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Rizvi S, Khan SA, Hallemeier CL, et al. Cholangiocarcinoma-evolving concepts and therapeutic strategies. Nat Rev Clin Oncol. 2018;15:95–111.

    Article  CAS  Google Scholar 

  2. El-Diwany R, Pawlik TM, Ejaz A. Intrahepatic cholangiocarcinoma. Surg Oncol Clin N Am. 2019;28:587–99.

    Article  Google Scholar 

  3. Wang Y, Li J, **a Y, et al. Prognostic nomogram for intrahepatic cholangiocarcinoma after partial hepatectomy. J Clin Oncol. 2013;31:1188–95.

    Article  Google Scholar 

  4. Bertuccio P, Malvezzi M, Carioli G, et al. Global trends in mortality from intrahepatic and extrahepatic cholangiocarcinoma. J Hepatol. 2019;71:104–14.

    Article  Google Scholar 

  5. Spolverato G, Kim Y, Alexandrescu S, et al. Management and outcomes of patients with recurrent intrahepatic cholangiocarcinoma following previous curative-intent surgical resection. Ann Surg Oncol. 2016;23:235–43. https://doi.org/10.1245/s10434-015-4642-9.

    Article  PubMed  Google Scholar 

  6. Navarro JG, Lee JH, Kang I, et al. Prognostic significance of and risk prediction model for lymph node metastasis in resectable intrahepatic cholangiocarcinoma: do all require lymph node dissection? HPB (Oxford). 2020;22:1411–9.

    Article  Google Scholar 

  7. Zhang X, Xue F, Dong D, et al. Number and station of lymph node metastasis after curative-intent resection of intrahepatic cholangiocarcinoma impact prognosis. Ann Surg. 2021;274:e1187–95.

    Article  Google Scholar 

  8. Zhang XF, Chen Q, Kimbrough CW, et al. Lymphadenectomy for intrahepatic cholangiocarcinoma: has nodal evaluation been increasingly adopted by surgeons over time? A national database analysis. J Gastrointest Surg. 2018;22:668–75.

    Article  Google Scholar 

  9. Amin MB, Edge SB, Greene FL, et al. AJCC cancer staging manual. 8th edn. New York: Springer; 2017.

    Book  Google Scholar 

  10. Yoh T, Cauchy F, Le Roy B, et al. Prognostic value of lymphadenectomy for long-term outcomes in node-negative intrahepatic cholangiocarcinoma: a multicenter study. Surgery. 2019;166:975–82.

    Article  Google Scholar 

  11. Kim DH, Choi DW, Choi SH, et al. Is there a role for systematic hepatic pedicle lymphadenectomy in intrahepatic cholangiocarcinoma? A review of 17 years of experience in a tertiary institution. Surgery. 2015;157:666–75.

    Article  Google Scholar 

  12. Zhang XF, Chakedis J, Bagante F, et al. Trends in use of lymphadenectomy in surgery with curative intent for intrahepatic cholangiocarcinoma. Br J Surg. 2018;105:857–66.

    Article  Google Scholar 

  13. Zhang XF, Lv Y, Weiss M, et al. Should utilization of lymphadenectomy vary according to morphologic subtype of intrahepatic cholangiocarcinoma? Ann Surg Oncol. 2019;26:2242–50. https://doi.org/10.1245/s10434-019-07336-5.

    Article  PubMed  Google Scholar 

  14. Kelley RK, Bridgewater J, Gores GJ, et al. Systemic therapies for intrahepatic cholangiocarcinoma. J Hepatol. 2020;72:353–63.

    Article  CAS  Google Scholar 

  15. Le Roy B, Gelli M, Pittau G, et al. Neoadjuvant chemotherapy for initially unresectable intrahepatic cholangiocarcinoma. Br J Surg. 2018;105:839–47.

    Article  Google Scholar 

  16. Malikowski T, Levy MJ, Gleeson FC, et al. Endoscopic ultrasound/fine needle aspiration is effective for lymph node staging in patients with cholangiocarcinoma. Hepatology. 2020;72:940–8.

    Article  CAS  Google Scholar 

  17. Meng ZW, Lin XQ, Zhu JH, et al. A nomogram to predict lymph node metastasis before resection in intrahepatic cholangiocarcinoma. J Surg Res. 2018;226:56–63.

    Article  Google Scholar 

  18. King MJ, Hectors S, Lee KM, et al. Outcomes assessment in intrahepatic cholangiocarcinoma using qualitative and quantitative imaging features. Cancer Imaging. 2020;20:43–5.

    Article  Google Scholar 

  19. Songthamwat M, Chamadol N, Khuntikeo N, et al. Evaluating a preoperative protocol that includes magnetic resonance imaging for lymph node metastasis in the holangiocarcinoma Screening and Care Program (CASCAP) in Thailand. World J Surg Oncol. 2017;15:176–80.

    Article  Google Scholar 

  20. Ma KW, Cheung TT, She WH, et al. Diagnostic and prognostic role of 18-FDG PET/CT in the management of resectable biliary tract cancer. World J Surg. 2018;42:823–34.

    Article  Google Scholar 

  21. Clements O, Eliahoo J, Kim JU, et al. Risk factors for intrahepatic and extrahepatic cholangiocarcinoma: a systematic review and meta-analysis. J Hepatol. 2020;72:95–103.

    Article  Google Scholar 

  22. Zhou Y, Zhou G, Gao X, et al. Apparent diffusion coefficient value of mass-forming intrahepatic cholangiocarcinoma: a potential imaging biomarker for prediction of lymph node metastasis. Abdom Radiol. 2020;45:3109–18.

    Article  Google Scholar 

  23. Huang YQ, Liang CH, He L, et al. Development and validation of a radiomics nomogram for preoperative prediction of lymph node metastasis in colorectal cancer. J Clin Oncol. 2016;34:2157–64.

    Article  Google Scholar 

  24. Lambin P, Leijenaar RTH, Deist TM, et al. Radiomics: the bridge between medical imaging and personalized medicine. Nat Rev Clin Oncol. 2017;14:749–62.

    Article  Google Scholar 

  25. Zhang S, Song G, Zang Y, et al. Non-invasive radiomics approach potentially predicts non-functioning pituitary adenomas subtypes before surgery. Eur Radiol. 2018;28:3692–701.

    Article  Google Scholar 

  26. Ji GW, Zhu FP, Zhang YD, et al. A radiomics approach to predict lymph node metastasis and clinical outcome of intrahepatic cholangiocarcinoma. Eur Radiol. 2019;29:3725–35.

    Article  Google Scholar 

  27. Ji GW, Zhang YD, Zhang H, et al. Biliary tract cancer at CT: a radiomics-based model to predict lymph node metastasis and survival outcomes. Radiology. 2019;290:90–8.

    Article  Google Scholar 

  28. Nagtegaal ID, Odze RD, Klimstra D, et al. WHO Classification of Tumours Editorial Board. WHO classification of tumours of the digestive system. Histopathology. 2019;2020(76):182–8.

    Google Scholar 

  29. Tsilimigras DI, Sahara K, Paredes AZ, et al. Predicting lymph node metastasis in intrahepatic cholangiocarcinoma. J Gastrointest Surg. 2021;25:1156–63.

    Article  Google Scholar 

  30. Cillo U, Fondevila C, Donadon M, et al. Surgery for cholangiocarcinoma. Liver Int. 2019;39(Suppl 1):143–55.

    Article  Google Scholar 

  31. Lee W, Jeong CY, Jang JY, et al. Clinical implication of tumor site in terms of node metastasis for intrahepatic cholangiocarcinoma. Eur J Surg Oncol. 2020;46:832–8.

    Article  Google Scholar 

  32. BForner A, Vidili G, Rengo M, et al. Clinical presentation, diagnosis and staging of cholangiocarcinoma. Liver Int. 2019;39(Suppl 1):98–107.

    Article  Google Scholar 

  33. Thoeny HC, Froehlich JM, Triantafyllou M, et al. Metastases in normal-sized pelvic lymph nodes: detection with diffusion-weighted MR imaging. Radiology. 2014;273:125–35.

    Article  Google Scholar 

  34. Chen Q, Zheng Y, Zhao H, et al. The combination of preoperative D-dimer and CA19-9 predicts lymph node metastasis and survival in intrahepatic cholangiocarcinoma patients after curative resection. Ann Transl Med. 2020;8:192–5.

    Article  CAS  Google Scholar 

  35. Yoh T, Hatano E, Seo S, et al. Preoperative criterion identifying a low-risk group for lymph node metastasis in intrahepatic cholangiocarcinoma. J Hepatobiliary Pancreat Sci. 2018;25:299–307.

    Article  Google Scholar 

  36. Lamarca A, Barriuso J, Chander A, et al. 18F-fluorodeoxyglucose positron emission tomography (18FDG-PET) for patients with biliary tract cancer: systematic review and meta-analysis. J Hepatol. 2019;71:115–29.

    Article  Google Scholar 

  37. Bedard PL, Hansen AR, Ratain MJ, et al. Tumour heterogeneity in the clinic. Nature. 2013;501:355–64.

    Article  CAS  Google Scholar 

  38. **ang F, Wei SM, Liu XY, et al. Radiomics analysis of contrast-enhanced CT for the preoperative prediction of microvascular invasion in mass-forming intrahepatic cholangiocarcinoma. Front Oncol. 2021;11:774117.

    Article  Google Scholar 

  39. Joo I, Lee JM, Yoon JH. Imaging diagnosis of intrahepatic and perihilar cholangiocarcinoma: recent advances and challenges. Radiology. 2018;288:7–13.

    Article  Google Scholar 

  40. Polan DF, Brady SL, Kaufman RA. Tissue segmentation of computed tomography images using a random forest algorithm: a feasibility study. Phys Med Biol. 2016;61:6553–69.

    Article  Google Scholar 

  41. Kim SY. Preoperative radiologic evaluation of cholangiocarcinoma. Korean J Gastroenterol. 2017;69:159–63.

    Article  Google Scholar 

Download references

Disclosure

None.

Funding

This study was supported by grants from National Natural Science Foundation of China (81772531 for J.L., 62027901 for J.T., 82102140 for S.Z., and 81930053 for J.W.), Program of Shanghai Academic/Technology Research Leader (19XD1425000 for J.L.), Program of Shanghai for Key Clinical Disciplines Construction (shslczdzk02402 for F.S.), Program of Shanghai for Medical Guide (18411968900 for J.L.), and Program of Shanghai for Clinical Skill Training and Clinical Practice Innovations (SHDC2020CR4027 for J.L., SHDC2020CR5007 and SHDC12019110 for F.S.).

Author information

Author notes

  1. Shuaitong Zhang, Shengyu Huang, Wei He, and **gwei Wei contributed equally to this work.

Authors and Affiliations

  1. CAS Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Bei**g, China

    Shuaitong Zhang PhD, **gwei Wei PhD & Jie Tian PhD

  2. School of Engineering Medicine, Beihang University, Bei**g, China

    Shuaitong Zhang PhD & Jie Tian PhD

  3. Department of Hepatobiliary and Pancreatic Surgery, Tenth People’s Hospital of Tongji University, Shanghai, China

    Shengyu Huang MD, Jianbo Lin MD & Jun Li MD

  4. Department of Hepatic Surgery IV, Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, China

    Shengyu Huang MD, Jianbo Lin MD, Feng Shen MD, PhD & Jun Li MD

  5. Department of Hepatobiliary Oncology, Sun Yat‐Sen University Cancer Center, Guangzhou, China

    Wei He MD

  6. Department of Radiotherapy, Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, China

    Lei Huo MD, Ningyang Jia MD & Yunfei Yuan MD

  7. Engineering Research Center of Molecular and Neuro Imaging of Ministry of Education, School of Life Science and Technology, **dian University, **’an, Shanxi, China

    Zhenchao Tang PhD & Jie Tian PhD

Authors
  1. Shuaitong Zhang PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Shengyu Huang MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Wei He MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. **gwei Wei PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Lei Huo MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ningyang Jia MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jianbo Lin MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Zhenchao Tang PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Yunfei Yuan MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Jie Tian PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Feng Shen MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Jun Li MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding authors

Correspondence to Jie Tian PhD, Feng Shen MD, PhD or Jun Li MD.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Zhang, S., Huang, S., He, W. et al. Radiomics-Based Preoperative Prediction of Lymph Node Metastasis in Intrahepatic Cholangiocarcinoma Using Contrast-Enhanced Computed Tomography. Ann Surg Oncol 29, 6786–6799 (2022). https://doi.org/10.1245/s10434-022-12028-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-022-12028-8

Search

Navigation