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Post-treatment CT LI-RADS categories: predictors of overall survival in hepatocellular carcinoma post bland transarterial embolization

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Abstract

Purpose

The LI-RADS Treatment Response (LR-TR) algorithm was introduced in 2017 to assist radiologists in assessing hepatocellular carcinoma (HCC) response following locoregional therapy. The objective of this study was to evaluate the associations between pre-treatment LI-RADS diagnostic categories, post-treatment LR-TR categories, and mRECIST response categories with overall survival (OS) of patients with HCC.

Methods

This retrospective study included untreated patients with one or two lesions who underwent transarterial embolization with or without concomitant ablation from December 2003 to December 2017. Two radiologists (R1 and R2) reviewed pre- and post-treatment CT imaging. Associations between pre- and post-treatment variables, including post-treatment LR-TR categories (Viable, Equivocal, Nonviable), with OS were assessed using the Kaplan–Meier method and Cox proportional hazards regression.

Results

Eighty-five patients were included (median age = 71 years, range 50–87; 17 women). The median OS from first embolization was 43.92 months. Pre- and post-treatment tumor size, pre-treatment LR-TIV (compared with LR-5), and post-treatment LR-TR Viable (compared with LR-TR Nonviable) were associated with OS (p < 0.05 for all). Median OS was shorter for LR-TR Viable patients (R1, 25.64 months, 95% CI 18.58–35.70; R2, 26.43 months 95% CI 20.68–43.92) than for LR-TR Nonviable patients (64.21 months R1 and R2, 95% CI 42.71–92.45 and 36.30–94.09, respectively). mRECIST categories showed similar associations with OS. Inter-reader agreement was moderate for LI-RADS categories (κ = 0.57, 95% CI 0.35–0.78) and substantial for LR-TR categories (κ = 0.68, 95% CI 0.55–0.81).

Conclusions

LR-TR categories show a strong association with OS in HCC patients treated with transarterial embolization.

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Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Consent to participate

For this type of study formal consent is not required.

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Acknowledgements

We thank Joanne Chin for editorial assistance.

Funding

This research was funded in part through the NIH/NCI Cancer Center Support Grant P30 CA008748.

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Authors and Affiliations

  1. Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, C-276F, New York, NY, 10065, USA

    William E. L. Ormiston, Hooman Yarmohammadi, Juliana Schilsky, Seth S. Katz, Maria LaGratta, Sara Velayati & Richard K. G. Do

  2. Department of Radiology, Auckland City Hospital, Auckland, New Zealand

    William E. L. Ormiston

  3. Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Stephanie Lobaugh, Junting Zheng & Marinela Capanu

Authors
  1. William E. L. Ormiston
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  2. Hooman Yarmohammadi
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  5. Seth S. Katz
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  10. Richard K. G. Do
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Contributions

WELO: Conceptualization, Data curation, Methodology, Data curation, Investigation, Validation, Writing—original draft, Writing—review & editing, Formal Analysis, Project administration, HY: Conceptualization, Methodology, Supervision, Writing—review & editing, SL: Formal Analysis, Visualization, Writing—review & editing, JS: Data curation, Investigation, Writing—review & editing, SK: Investigation, Writing—review & editing, ML: Investigation, Writing—review & editing, SV: Data curation, Writing—review & editing, JZ: Formal Analysis, Visualization, Writing—review & editing, MC: Formal Analysis, Visualization, Writing—review & editing, RKGD: Conceptualization, Methodology, Investigation, Supervision, Validation, Writing—review & editing, Project administration.

Corresponding author

Correspondence to Richard K. G. Do.

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The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (institutional review board at Memorial Sloan Kettering cancer Center, IRB #18-370 and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

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Ormiston, W.E.L., Yarmohammadi, H., Lobaugh, S. et al. Post-treatment CT LI-RADS categories: predictors of overall survival in hepatocellular carcinoma post bland transarterial embolization. Abdom Radiol 46, 3738–3747 (2021). https://doi.org/10.1007/s00261-020-02775-1

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