Real‐world efficacy of radiomics versus clinical predictors for microvascular invasion in patients with hepatocellular carcinoma: Large cohort study

Abstract Aim Microvascular invasion (MVI) affects the prognosis and treatment of hepatocellular carcinoma (HCC); however, its preoperative diagnosis is challenging. Analysis of computed tomography (CT) images using radiomics can detect MVI, but its effectiveness depends on the imaging conditions. We compared the efficacies of radiomics, clinical, and combined models for predicting MVI in HCC using nonstandardized scanning protocols. Methods This multicenter study included 533 patients who underwent hepatic resection for HCC. Patients were divided randomly into training ( n = 426) and test groups ( n = 107). We manually extracted 3D CT features in hepatic arterial, portal venous, and venous phases. The radiomics model was trained by machine learning. A logistic regression model was developed based on clinical information, and a fused model was created integrating clinical information and radiomics prediction score (Rad_Score). We calculated areas under the receiver operating characteristic curves (AUCs) for the radiomics, clinical, and mixed models in the test groups. Results The clinical model incorporated hepatitis B virus surface antigen, tumor diameter, and log‐transformed α ‐fetoprotein and des‐gamma‐carboxyprothrombin. The AUCs of the radiomics and clinical models were comparable ( p = 0.76). Rad_Score was not an independent significant factor in the fused model ( p = 0.40) and its addition did not improve the accuracy of the clinical model alone ( p = 0.51). Conclusions A clinical model is as effective as a CT radiomics model for predicting MVI status in patients with HCC based on real‐world scanning data, and integration of both models does not improve the predictive performance compared with a clinical model alone.