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

ObjectivesTo evaluate the value of CT attenuation to assess the response to sorafenib in infiltrative/endovascular non-measurable advanced hepatocellular carcinoma (HCC).MethodsFrom 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.ResultsForty 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 41months (95% CI: 2.1-5.9), with estimated OS rates at 6, 12, and 24months 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.ConclusionDespite 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 center dot Attenuation of both tumors and tumor-in-vein decreases after sorafenib. center dot Attenuation decrease is more marked in the tumor-in-vein than in the tumor. center dot Attenuation decrease is not associated with longer overall survival.