Fushuang Liu,* Lijun Chen,* Qiaoyuan Wu, Liqing Li, Jizhou Li, Tingshi Su, Jianxu Li, Shixiong Liang, Liping Qing

Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, 530001, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Shixiong Liang, Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, 71 he-Di Road, Nanning, 530001, People’s Republic of China, Tel +8613917716605, Email liangshixionglsx@163.com Liping Qing, Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, 71 he-Di Road, Nanning, 530001, People’s Republic of China, Tel +8615777191169, Email 371205428@qq.com

Objective: To develop an interpretable machine learning (ML) model using dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) radiomic data, dosimetric parameters, and clinical data for predicting radiation-induced hepatic toxicity (RIHT) in patients with hepatocellular carcinoma (HCC) following intensity-modulated radiation therapy (IMRT).
Methods: A retrospective analysis of 150 HCC patients was performed, with a 7:3 ratio used to divide the data into training and validation cohorts. Radiomic features from the original MRI sequences and Delta-radiomic features were extracted. Seven ML models based on radiomics were developed: logistic regression (LR), random forest (RF), support vector machine (SVM), eXtreme Gradient Boosting (XGBoost), adaptive boosting (AdaBoost), decision tree (DT), and artificial neural network (ANN). The predictive performance of the models was evaluated using receiver operating characteristic (ROC) curve analysis and calibration curves. Shapley additive explanations (SHAP) were employed to interpret the contribution of each variable and its risk threshold.
Results: Original radiomic features and Delta-radiomic features were extracted from DCE-MRI images and filtered to generate Radiomics-scores and Delta-Radiomics-scores. These were then combined with independent risk factors (Body Mass Index (BMI), V5, and pre-Child-Pugh score(pre-CP)) identified through univariate and multivariate logistic regression and Spearman correlation analysis to construct the ML models. In the training cohort, the AUC values were 0.8651 for LR, 0.7004 for RF, 0.6349 for SVM, 0.6706 for XGBoost, 0.7341 for AdaBoost, 0.6806 for Decision Tree, and 0.6786 for ANN. The corresponding accuracies were 84.4%, 65.6%, 75.0%, 65.6%, 71.9%, 68.8%, and 71.9%, respectively. The validation cohort further confirmed the superiority of the LR model, which was selected as the optimal model. SHAP analysis revealed that Delta-radiomics made a substantial positive contribution to the model.
Conclusion: The interpretable ML model based on radiomics provides a non-invasive tool for predicting RIHT in patients with HCC, demonstrating satisfactory discriminative performance.

Keywords: radiation-induced hepatic toxicity, radiomics, hepatocellular carcinoma, MRI, machine learning