Reliable prediction of survival in advanced-stage hepatocellular carcinoma treated with sorafenib: comparing 1D and 3D quantitative tumor response criteria on MRI

• Published in: European radiology Vol. 31; no. 5; pp. 2737 - 2746
• Main Authors: Doemel, Luzie A., Chapiro, Julius, Laage Gaupp, Fabian, Savic, Lynn Jeanette, Kucukkaya, Ahmet S., Petukhova, Alexandra, Tefera, Jonathan, Zeevi, Tal, Lin, MingDe, Schlachter, Todd, Jaffe, Ariel, Strazzabosco, Mario, Patel, Timil, Stein, Stacey M.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.05.2021; Springer Nature B.V
• Subjects: Antineoplastic Agents - therapeutic use; Carcinoma, Hepatocellular - diagnostic imaging; Carcinoma, Hepatocellular - drug therapy; Correlation; Criteria; Diagnostic Radiology; Disease control; Hepatocellular carcinoma; Humans; Imaging; Inhibitor drugs; Internal Medicine; Interventional Radiology; Lesions; Liver cancer; Liver Neoplasms - diagnostic imaging; Liver Neoplasms - drug therapy; Magnetic Resonance Imaging; Medical prognosis; Medicine; Medicine & Public Health; Neuroradiology; Oncology; Phenylurea Compounds - therapeutic use; Radiology; Rank tests; Regression models; Retrospective Studies; Risk analysis; Risk factors; Segmentation; Sorafenib - therapeutic use; Survival; Targeted cancer therapy; Therapy; Treatment Outcome; Tumors; Ultrasound; Carcinoma, hepatocellular; Treatment outcome; Magnetic resonance imaging; Kaplan-Meier estimate; Sorafenib
• ISSN: 0938-7994; 1432-1084
• DOI: 10.1007/s00330-020-07381-9

Objectives To compare 1D and 3D quantitative tumor response criteria applied to DCE-MRI in patients with advanced-stage HCC undergoing sorafenib therapy to predict overall survival (OS) early during treatment. Methods This retrospective analysis included 29 patients with advanced-stage HCC who received sorafenib for at least 60 days. All patients underwent baseline and follow-up DCE-MRI at 81.5 ± 29.3 days (range 35–140 days). Response to sorafenib was assessed in 46 target lesions using 1D criteria RECIST1.1 and mRECIST. In addition, a segmentation-based 3D quantification of absolute enhancing lesion volume (vqEASL) was performed on the arterial phase MRI, and the enhancement fraction of total tumor volume (%qEASL) was calculated. Accordingly, patients were stratified into groups of disease control (DC) and disease progression (DP). OS was evaluated using Kaplan-Meier curves with log-rank test and Cox proportional hazards regression model. Results The Kaplan-Meier analysis revealed that stratification of patients in DC vs. DP according to mRECIST ( p  = 0.0371) and vqEASL ( p  = 0.0118) successfully captured response and stratified OS, while stratification according to RECIST and %qEASL did not correlate with OS ( p  = 0.6273 and p  = 0.7474, respectively). Multivariable Cox regression identified tumor progression according to mRECIST and qEASL as independent risk factors of decreased OS ( p  = 0.039 and p  = 0.006, respectively). Conclusions The study identified enhancement-based vqEASL and mRECIST as reliable predictors of patient survival early after initiation of treatment with sorafenib. This data provides evidence for potential advantages 3D quantitative, enhancement-based tumor response analysis over conventional techniques regarding early identification of treatment success or failure. Key Points • Tumor response criteria on MRI can be used to predict survival benefit of sorafenib therapy in patients with advanced HCC. • Stratification into DC and DP using mRECIST and vqEASL significantly correlates with OS (p = 0.0371 and p = 0.0118, respectively) early after initiation of sorafenib, while stratification according to RECIST and %qEASL did not correlate with OS (p = 0.6273 and p = 0.7474, respectively). • mRECIST (HR = 0.325, p = 0.039. 95%CI 0.112–0.946) and qEASL (HR = 0.183, p = 0.006, 95%CI 0.055–0.613) are independent prognostic factors of survival in HCC patients undergoing sorafenib therapy.