CT-Based Nested Habitats Analysis for Early Recurrence Prediction and Risk Stratification in Hepatocellular Carcinoma: Development and Multicenter Validation Across Four Cohorts
摘要
The purpose of this study was to develop and validate a computed tomography (CT)–based nested habitats analysis for identifying aggressive tumor subregions and predicting early recurrence in patients with hepatocellular carcinoma (HCC).
Patients and MethodsPatients from three institutions were allocated to a training cohort (n = 372) and an internal validation cohort (n = 160) at a 7:3 ratio. An external validation cohort (n = 169) from a fourth institution was included. Venous-phase CT images underwent nested habitats analysis to locate aggressive subregions. First, a support vector machine classified tumors on the basis of global radiomic features. Then, local features were extracted to construct probability maps, from which aggressive micro-regions were identified using k-means clustering. Features from the highest-risk micro-regions were integrated to generate a nested habitats score. Model performance was evaluated with the area under the curve (AUC) and Kaplan–Meier survival analysis.
ResultsThe nested habitats score demonstrated strong predictive ability for early recurrence, achieving AUCs of 0.832 (95% CI 0.778–0.885) in the training cohort, 0.896 (95% CI 0.833–0.959) in the internal validation cohort, and 0.833 (95% CI 0.762–0.905) in the external validation cohort. In multivariable Cox regression, the nested habitats score remained an independent predictor of recurrence-free survival (RFS) (P < 0.05), along with alkaline phosphatase, macrotrabecular-massive HCC, sex, and intratumoral tertiary lymphoid structures. Kaplan–Meier analysis further confirmed significantly shorter RFS among patients with high nested habitats scores or high nomogram-predicted risk (P < 0.05).
ConclusionsThe CT-based nested habitats analysis effectively captures intratumoral heterogeneity and accurately predicts early recurrence in HCC. This technique enables precise postoperative risk stratification.