Journal
ABDOMINAL RADIOLOGY
Volume 46, Issue 8, Pages 3738-3747Publisher
SPRINGER
DOI: 10.1007/s00261-020-02775-1
Keywords
Locoregional therapy; Treatment response; RECIST; Computed tomography
Funding
- NIH/NCI Cancer Center Support Grant [P30 CA008748]
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The study evaluated the prognostic factors in HCC patients treated with locoregional therapy and found a strong association between LR-TR categories and overall survival.
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 (kappa = 0.57, 95% CI 0.35-0.78) and substantial for LR-TR categories (kappa = 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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