Does Enhancement or Perfusion on Preprocedure CT Predict Outcomes After Embolization of Hepatocellular Carcinoma?

Overview

Journal Acad Radiol

Specialty Radiology

Date 2018 Apr 1

PMID 29602726

Citations 21

Authors

Alessandra Borgheresi

Adrian Gonzalez-Aguirre

Karen T Brown

George I Getrajdman

Joseph P Erinjeri

Anne Covey

Hooman Yarmohammadi

Etay Ziv

Constantinos T Sofocleous

Franz Edward Boas

Affiliations

Soon will be listed here.

Abstract

Rationale And Objective: The objective of this study was to evaluate whether quantitative enhancement or perfusion measurements on preprocedure triphasic computed tomography (CT) can be used to predict response or overall survival after embolization of hepatocellular carcinoma.

Materials And Methods: The institutional review board approved this retrospective review of 63 patients with hepatocellular carcinoma treated with particle embolization between March 2009 and December 2014. Quantitative enhancement and perfusion measurements were performed on the target tumor and the background liver on the triphasic CT performed before treatment. Microvascular invasion (MVI) and degree of differentiation were determined from a core biopsy specimen. Quantitative enhancement and perfusion values were then correlated with pathology (two-tailed t test), response to embolization on modified Response Evaluation Criteria In Solid Tumors (two-tailed t test), and overall survival after embolization (Cox proportional hazards model).

Results: Arterial enhancement did not predict immediate response or overall survival after embolization. The degree of differentiation or presence of MVI also did not predict immediate response or overall survival after embolization. However, high hepatic artery coefficient or low portal vein coefficient, both in the tumor (P = .011 and P = .004) and in the background liver (P = .015 and P = .009), were associated with worse survival. Hepatic artery coefficient, both in the tumor (P = .025) and in the background liver (P = .013), were independent predictors of survival in a multivariate model including the Child-Pugh score and the BCLC stage.

Conclusions: Tumor and liver perfusion parameters estimated from preprocedure triphasic CT were predictive of survival after embolization. Arterial-phase enhancement and histology (degree of differentiation or MVI) did not predict immediate response or overall survival after particle embolization.

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References

Jonas S, Bechstein W, Steinmuller T, Herrmann M, Radke C, Berg T . Vascular invasion and histopathologic grading determine outcome after liver transplantation for hepatocellular carcinoma in cirrhosis. Hepatology. 2001; 33(5):1080-6. DOI: 10.1053/jhep.2001.23561. View

Kitao A, Zen Y, Matsui O, Gabata T, Nakanuma Y . Hepatocarcinogenesis: multistep changes of drainage vessels at CT during arterial portography and hepatic arteriography--radiologic-pathologic correlation. Radiology. 2009; 252(2):605-14. DOI: 10.1148/radiol.2522081414. View

Salem R, Gordon A, Mouli S, Hickey R, Kallini J, Gabr A . Y90 Radioembolization Significantly Prolongs Time to Progression Compared With Chemoembolization in Patients With Hepatocellular Carcinoma. Gastroenterology. 2016; 151(6):1155-1163.e2. PMC: 5124387. DOI: 10.1053/j.gastro.2016.08.029. View

Lencioni R, Llovet J . Modified RECIST (mRECIST) assessment for hepatocellular carcinoma. Semin Liver Dis. 2010; 30(1):52-60. DOI: 10.1055/s-0030-1247132. View

Hu H, Kim J, Lee L, Kim K, Ko G, Yoon H . Chemoembolization for hepatocellular carcinoma: multivariate analysis of predicting factors for tumor response and survival in a 362-patient cohort. J Vasc Interv Radiol. 2011; 22(7):917-23. DOI: 10.1016/j.jvir.2011.03.005. View

Gulberg V, Haag K, Rossle M, Gerbes A . Hepatic arterial buffer response in patients with advanced cirrhosis. Hepatology. 2002; 35(3):630-4. DOI: 10.1053/jhep.2002.31722. View

Boas F, Brody L, Erinjeri J, Yarmohammadi H, Shady W, Kishore S . Quantitative Measurements of Enhancement on Preprocedure Triphasic CT Can Predict Response of Colorectal Liver Metastases to Radioembolization. AJR Am J Roentgenol. 2016; 207(3):671-5. PMC: 5003600. DOI: 10.2214/AJR.15.15767. View

Lee E, Kim S, Park H, Lee S, Lee S, Park S . Survival analysis after liver resection for hepatocellular carcinoma: A consecutive cohort of 1002 patients. J Gastroenterol Hepatol. 2016; 32(5):1055-1063. DOI: 10.1111/jgh.13632. View

Budczies J, Klauschen F, Sinn B, Gyorffy B, Schmitt W, Darb-Esfahani S . Cutoff Finder: a comprehensive and straightforward Web application enabling rapid biomarker cutoff optimization. PLoS One. 2012; 7(12):e51862. PMC: 3522617. DOI: 10.1371/journal.pone.0051862. View

10.

Herber S, Biesterfeld S, Franz U, Schneider J, Thies J, Schuchmann M . Correlation of multislice CT and histomorphology in HCC following TACE: predictors of outcome. Cardiovasc Intervent Radiol. 2008; 31(4):768-77. DOI: 10.1007/s00270-007-9270-8. View

11.

Boas F, Kamaya A, Do B, Desser T, Beaulieu C, Vasanawala S . Classification of hypervascular liver lesions based on hepatic artery and portal vein blood supply coefficients calculated from triphasic CT scans. J Digit Imaging. 2014; 28(2):213-23. PMC: 4359206. DOI: 10.1007/s10278-014-9725-9. View

12.

Katyal S, Oliver J, Peterson M, Chang P, BARON R, Carr B . Prognostic significance of arterial phase CT for prediction of response to transcatheter arterial chemoembolization in unresectable hepatocellular carcinoma: a retrospective analysis. AJR Am J Roentgenol. 2000; 175(6):1665-72. DOI: 10.2214/ajr.175.6.1751665. View

13.

Lim K, Chow P, Allen J, Chia G, Lim M, Cheow P . Microvascular invasion is a better predictor of tumor recurrence and overall survival following surgical resection for hepatocellular carcinoma compared to the Milan criteria. Ann Surg. 2011; 254(1):108-13. DOI: 10.1097/SLA.0b013e31821ad884. View

14.

Biederman D, Titano J, Tabori N, Pierobon E, Alshebeeb K, Schwartz M . Outcomes of Radioembolization in the Treatment of Hepatocellular Carcinoma with Portal Vein Invasion: Resin versus Glass Microspheres. J Vasc Interv Radiol. 2016; 27(6):812-821.e2. DOI: 10.1016/j.jvir.2016.01.147. View

15.

Brown K, Do R, Gonen M, Covey A, Getrajdman G, Sofocleous C . Randomized Trial of Hepatic Artery Embolization for Hepatocellular Carcinoma Using Doxorubicin-Eluting Microspheres Compared With Embolization With Microspheres Alone. J Clin Oncol. 2016; 34(17):2046-53. PMC: 4966514. DOI: 10.1200/JCO.2015.64.0821. View

16.

Kwan S, Fidelman N, Ma E, Kerlan Jr R, Yao F . Imaging predictors of the response to transarterial chemoembolization in patients with hepatocellular carcinoma: a radiological-pathological correlation. Liver Transpl. 2012; 18(6):727-36. PMC: 4161220. DOI: 10.1002/lt.23413. View

17.

Choi J, Lee J, Sirlin C . CT and MR imaging diagnosis and staging of hepatocellular carcinoma: part I. Development, growth, and spread: key pathologic and imaging aspects. Radiology. 2014; 272(3):635-54. PMC: 4263631. DOI: 10.1148/radiol.14132361. View

18.

Sato K, Omary R, Takehana C, Ibrahim S, Lewandowski R, Ryu R . The role of tumor vascularity in predicting survival after yttrium-90 radioembolization for liver metastases. J Vasc Interv Radiol. 2009; 20(12):1564-9. DOI: 10.1016/j.jvir.2009.08.013. View

19.

Artinyan A, Nelson R, Soriano P, Chung V, Retseck J, Reynolds J . Treatment response to transcatheter arterial embolization and chemoembolization in primary and metastatic tumors of the liver. HPB (Oxford). 2008; 10(6):396-404. PMC: 2597318. DOI: 10.1080/13651820802356564. View