Objective: The aim of this study was to develop a radiomics-based prediction model for the response of colorectal liver metastases to oxaliplatin-based chemotherapy. Methods: Forty-two consecutive patients treated with oxaliplatin-based first-line chemotherapy for colorectal liver metastasis at our institution from August 2013 to October 2019 were enrolled in this retrospective study. Overall, 126 liver metastases were chronologically divided into the training (n = 94) and validation (n = 32) cohorts. Regions of interest were manually segmented, and the best response to chemotherapy was decided based on Response Evaluation Criteria in Solid Tumors (RECIST). Patients who achieved clinical complete and partial response according to RECIST were defined as good responders. Radiomics features were extracted from the pretreatment enhanced computed tomography scans, and a radiomics score was calculated using the least absolute shrinkage and selection operator regression model in a trial cohort. Results: The radiomics score significantly discriminated good responders in both the trial (area under the curve [AUC] 0.8512, 95% confidence interval [CI] 0.7719–0.9305; p < 0.0001) and validation (AUC 0.7792, 95% CI 0.6176–0.9407; p < 0.0001) cohorts. Multivariate analysis revealed that high radiomics scores greater than − 0.06 (odds ratio [OR] 23.803, 95% CI 8.432–80.432; p < 0.0001), clinical non-T4 (OR 6.054, 95% CI 2.164–18.394; p = 0.0005), and metachronous disease (OR 11.787, 95% CI 2.333–70.833; p = 0.0025) were independently associated with good response. Conclusions: Radiomics signatures may be a potential biomarker for the early prediction of chemosensitivity in colorectal liver metastases. This approach may support the treatment strategy for colorectal liver metastasis.
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