Objective:To investigate the performance of MRI in predicting progression-free sur-vival(PFS)for unresectable intrahepatic cholangiocarcinoma(iCCA)treated with combination of chemotherapy and targeted-immunotherapy.Methods:A total of 23 biopsy-confirmed iCCA patients who received Gemox chemotherapy in combination with lenvatinib and anti-PD-1 antibody were in-cluded.The clinical and imaging independent risk factors for disease progression after treatment were analyzed by log-rank test and Cox regression model,and the nomogram for PFS prediction was subse-quently established.Results:Disease progression was identified in 15 of the 23 patients during follow-up with an overall 1-year PFS rate of only 33.5％.The results of multivariate analysis showed that arterial peritumoral enhancement(APE)(hazard ratio(HR)=5.747,P=0.029),hemorrhage(HR=5.460,P=0.033)and apparent diffusion coefficient(ADC)≤1.273 × 10 3mm2/s(HR=6.261,P=0.004)were independent risk factors for disease progression.The 1-year PFS rates were significantly lower in patients with APE,hemorrhage and low ADC,in comparison to their counterparts(P=0.0045,0.013 and 0.002,respectively).The nomogram incorporating the above three independent imaging features exhibited satisfactory predictive performance with a C-index value of 0.856(95％CI:0.785～0.927),superior to any single imaging feature alone(P=0.0015～0.022).Conclusion:Contrast-enhanced MRI combined with diffusion-weighted MRI and nomogram could achieve an improved predictive perform-ance in PFS prediction for unresectable iCCA treated with combination of chemotherapy and targeted-immunotherapy.
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