Non-measurable infiltrative HCC: is post-contrast attenuation on CT a sign of tumor response?

Abstract

Objectives

To evaluate the value of CT attenuation to assess the response to sorafenib in infiltrative/endovascular non-measurable advanced hepatocellular carcinoma (HCC).

Methods

From 2007 to 2014, patients with infiltrative HCC ± tumor-in-vein (TIV) were retrospectively included. Attenuation of tumors and TIV were measured at baseline and follow-up on arterial and portal venous phase CT by two independent radiologists. Attenuation changes (overall and as per Choi criteria) and Child-Pugh score were correlated to overall survival.

Results

Forty patients were included (38 men, 95%). Attenuation of both the tumors and TIV was significantly lower in follow-up CT than on baseline CT (p = 0.002 (arterial), and p = 0.001 (portal) for tumor, and p = 0.004 (arterial) and p < 0.001 (porta) for TIV). Median attenuation of TIV was significantly lower than that of the tumor in follow-up images (p = 0.010). Median OS for the entire cohort was 4 ± 1 months (95% CI: 2.1–5.9), with estimated OS rates at 6, 12, and 24 months of 43%, 29 and 12%, respectively. Baseline and follow-up CT attenuation in tumors and TVI were not correlated with survival. Survival was not significantly increased in patients with Choi criteria >15% CT HU decrease in the tumor and/or TIV during follow-up. Only Child-Pugh A (HR 4.9 (95%CI 2.3–10.7), p < 0.001) was identified as an independent factor of improved survival on multivariate analysis.

Conclusion

Despite significant changes under sorafenib, tumor attenuation of infiltrative/endovascular non-measurable HCC may be of limited value to assess survival in this subgroup of patients with very poor prognosis.

Key Points

• Attenuation of both tumors and tumor-in-vein decreases after sorafenib.

• Attenuation decrease is more marked in the tumor-in-vein than in the tumor.

• Attenuation decrease is not associated with longer overall survival.

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Abbreviations

AFP:

Alpha-fetoprotein

BCLC:

Barcelona Clinic Liver Cancer

CT:

Computed tomography

EASL:

European Association for the Study of the Liver

HCC:

Hepatocellular carcinoma

ICC:

Intraclass correlation coefficient

(m)RECIST:

(modified) Response Criteria In Solid Tumors

ROI:

Region of interest

TIV:

Tumor-in-vein

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Funding

The authors state that this work has not received any funding.

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Correspondence to Maxime Ronot.

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The scientific guarantor of this publication is Maxime Ronot.

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The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

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Institutional Review Board approval was obtained.

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Written informed consent was waived by the Institutional Review Board.

Methodology

• retrospective

• diagnostic or prognostic study

• single-center study

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Koulakian, H., Allaham, W., Vilgrain, V. et al. Non-measurable infiltrative HCC: is post-contrast attenuation on CT a sign of tumor response?. Eur Radiol 29, 4389–4399 (2019). https://doi.org/10.1007/s00330-018-5805-4

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Keywords

  • Sorafenib
  • Carcinoma, hepatocellular
  • Portal vein
  • Follow-up studies