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European Radiology
Published in: European Radiology 9/2016

01-09-2016 | Interventional

3D Quantitative tumour burden analysis in patients with hepatocellular carcinoma before TACE: comparing single-lesion vs. multi-lesion imaging biomarkers as predictors of patient survival

Authors: Florian N. Fleckenstein, Rüdiger E. Schernthaner, Rafael Duran, Jae Ho Sohn, Sonia Sahu, Yan Zhao, Bernd Hamm, Bernhard Gebauer, MingDe Lin, Jean-François Geschwind, Julius Chapiro

Published in: European Radiology | Issue 9/2016

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Abstract

Objectives

To compare the ability of single- vs. multi-lesion assessment on baseline MRI using 1D- and 3D-based measurements to predict overall survival (OS) in patients with hepatocellular carcinoma (HCC) before transarterial chemoembolization (TACE).

Methods

This retrospective analysis included 122 patients. A quantitative 3D analysis was performed on baseline MRI to calculate enhancing tumour volume (ETV [cm3]) and enhancing tumour burden (ETB [%]) (ratio between ETV [cm3] and liver volume). Furthermore, enhancing and overall tumour diameters were measured. Patients were stratified into two groups using thresholds derived from the BCLC staging system. Statistical analysis included Kaplan–Meier plots, uni- and multivariate cox proportional hazard ratios (HR) and concordances.

Results

All methods achieved good separation of the survival curves (p < 0.05). Multivariate analysis showed an HR of 5.2 (95 % CI 3.1–8.8, p < 0.001) for ETV [cm3] and HR 6.6 (95 % CI 3.7–11.5, p < 0.001) for ETB [%] vs. HR 2.6 (95 % CI 1.2–5.6, p = 0.012) for overall diameter and HR 3.0 (95 % CI 1.5–6.3, p = 0.003) for enhancing diameter. Concordances were highest for ETB [%], with no added predictive power for multi-lesion assessment (difference between concordances not significant).

Conclusion

3D quantitative assessment is a stronger predictor of survival as compared to diameter-based measurements. Assessing multiple lesions provides no substantial improvement in predicting OS than evaluating the dominant lesion alone.

Key Points

• 3D quantitative tumour assessment on baseline MRI predicts survival in HCC patients.
• 3D quantitative tumour assessment predicts survival better than any current radiological method.
• Multiple lesion assessment provides no improvement than evaluating the dominant lesion alone.
• Measuring enhancing tumour volume in proportion to liver volume reflects tumour burden.
Literature
1.
European Association for the Study of the Liver, European Organisation for Research and Treatment of Cancer (2012) EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma. J Hepatol 56:908–943CrossRef
2.
Ferlay J, Soerjomataram I, Dikshit R et al (2015) Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer 136:E359–E386CrossRefPubMed
3.
WHO International Agency for Research on Cancer (2014) Global battle against cancer won’t be won with treatment alone: effective prevention measures urgently needed to prevent cancer crisis. The International Agency for Research on Cancer, Lyon/London
4.
Bruix J, Llovet JM (2002) Prognostic prediction and treatment strategy in hepatocellular carcinoma. Hepatology 35:519–524CrossRefPubMed
5.
Yuen MF, Cheng CC, Lauder IJ, Lam SK, Ooi CG, Lai CL (2000) Early detection of hepatocellular carcinoma increases the chance of treatment: Hong Kong experience. Hepatology 31:330–335CrossRefPubMed
6.
7.
Benson AB 3rd, Abrams TA, Ben-Josef E et al (2009) NCCN clinical practice guidelines in oncology: hepatobiliary cancers. J Natl Compr Canc Netw 7:350–391PubMedPubMedCentral
8.
Llovet JM, Bru C, Bruix J (1999) Prognosis of hepatocellular carcinoma: the BCLC staging classification. Semin Liver Dis 19:329–338CrossRefPubMed
9.
Yau T, Tang VYF, Yao T-J, Fan S-T, Lo C-M, Poon RTP (2014) Development of Hong Kong Liver Cancer staging system with treatment stratification for patients with hepatocellular carcinoma. Gastroenterology 146:1691–1700.e1693
10.
Cancer of the Liver Italian Program (CLIP) investigators (1998) A new prognostic system for hepatocellular carcinoma: a retrospective study of 435 patients. Hepatology 28:751–755CrossRef
11.
Lin M, Pellerin O, Bhagat N et al (2012) Quantitative and volumetric European Association for the Study of the Liver and Response Evaluation Criteria in Solid Tumors measurements: feasibility of a semiautomated software method to assess tumor response after transcatheter arterial chemoembolization. J Vasc Interv Radiol 23:1629–1637CrossRefPubMedPubMedCentral
12.
Chapiro J, Wood LD, Lin M et al (2014) Radiologic-pathologic analysis of contrast-enhanced and diffusion-weighted MR imaging in patients with HCC after TACE: diagnostic accuracy of 3D quantitative image analysis. Radiology 273:746–758CrossRefPubMedPubMedCentral
13.
Tacher V, Lin M, Duran R et al (2015) Comparison of existing response criteria in patients with hepatocellular carcinoma treated with TACE using a 3D quantitative approach. Radiology. doi:10.​1148/​radiol.​2015142951
14.
15.
Duran R, Chapiro J, Frangakis C et al (2014) Uveal melanoma metastatic to the liver: the role of quantitative volumetric contrast-enhanced MR imaging in the assessment of early tumor response after transarterial chemoembolization. Transl Oncol 7:447–455CrossRefPubMedPubMedCentral
16.
Chapiro J, Duran R, Lin M et al (2015) Early survival prediction after intra-arterial therapies: a 3D quantitative MRI assessment of tumour response after TACE or radioembolization of colorectal cancer metastases to the liver. Eur Radiol. doi:10.​1007/​s00330-015-3595-5
17.
Chapiro J, Duran R, Lin M et al (2014) Identifying staging markers for hepatocellular carcinoma before transarterial chemoembolization: comparison of three-dimensional quantitative versus non-three-dimensional imaging markers. Radiology. doi:10.​1148/​radiol.​14141180:​141180
18.
Kim BK, Kim SU, Kim MJ et al (2013) Number of target lesions for EASL and modified RECIST to predict survivals in hepatocellular carcinoma treated with chemoembolization. Clin Cancer Res 19:1503–1511CrossRefPubMed
19.
Bogaerts J, Ford R, Sargent D et al (2009) Individual patient data analysis to assess modifications to the RECIST criteria. Eur J Cancer 45:248–260CrossRefPubMed
20.
Lee H, Chapiro J, Schernthaner R et al (2015) How I do it: a practical database management system to assist clinical research teams with data collection, organization, and reporting. Acad Radiol 22:527–533CrossRefPubMedPubMedCentral
21.
22.
Therasse P, Arbuck SG, Eisenhauer EA et al (2000) New guidelines to evaluate the response to treatment in solid tumors. European Organization for Research and Treatment of Cancer, National Cancer Institute of the United States, National Cancer Institute of Canada. J Natl Cancer Inst 92:205–216CrossRefPubMed
23.
Eisenhauer EA, Therasse P, Bogaerts J et al (2009) New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer 45:228–247CrossRefPubMed
24.
Lencioni R, Llovet JM (2010) Modified RECIST (mRECIST) assessment for hepatocellular carcinoma. Semin Liver Dis 30:52–60CrossRefPubMed
25.
Tacher V, Lin M, Chao M et al (2013) Semiautomatic volumetric tumor segmentation for hepatocellular carcinoma: comparison between C-arm cone beam computed tomography and MRI. Acad Radiol 20:446–452CrossRefPubMedPubMedCentral
26.
27.
Chockalingam A, Duran R, Sohn JH, Geschwind JF (2016) Radiologic-pathologic analysis of quantitative 3D tumor enhancement on contrast-enhanced MR imaging: a study of ROI placement. Eur Radiol 26:103–113CrossRefPubMed
28.
Chapiro J, Geschwind JF (2014) Hepatocellular carcinoma: have we finally found the ultimate staging system for HCC? Nat Rev Gastroenterol Hepatol 11:334–336CrossRefPubMed
29.
Llovet JM, Schwartz M, Mazzaferro V (2005) Resection and liver transplantation for hepatocellular carcinoma. Semin Liver Dis 25:181–200CrossRefPubMed
30.
Mazzaferro V, Regalia E, Doci R et al (1996) Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis. N Engl J Med 334:693–699CrossRefPubMed
31.
Thiesse P, Ollivier L, Di Stefano-Louineau D et al (1997) Response rate accuracy in oncology trials: reasons for interobserver variability Groupe Francais d'Immunotherapie of the Federation Nationale des Centres de Lutte Contre le Cancer. J Clin Oncol 15:3507–3514PubMed
32.
Kashkoush S, El Moghazy W, Kawahara T, Gala-Lopez B, Toso C, Kneteman NM (2014) Three-dimensional tumor volume and serum alpha-fetoprotein are predictors of hepatocellular carcinoma recurrence after liver transplantation: refined selection criteria. Clin Transplant 28:728–736CrossRefPubMed
33.
Corona-Villalobos CP, Halappa VG, Bonekamp S et al (2014) Functional magnetic resonance imaging response of targeted tumor burden and its impact on survival in patients with hepatocellular carcinoma. Invest Radiol. doi:10.​1097/​RLI.​0000000000000112​
Metadata
Title
3D Quantitative tumour burden analysis in patients with hepatocellular carcinoma before TACE: comparing single-lesion vs. multi-lesion imaging biomarkers as predictors of patient survival
Authors
Florian N. Fleckenstein
Rüdiger E. Schernthaner
Rafael Duran
Jae Ho Sohn
Sonia Sahu
Yan Zhao
Bernd Hamm
Bernhard Gebauer
MingDe Lin
Jean-François Geschwind
Julius Chapiro
Publication date
01-09-2016
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 9/2016
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-015-4168-3

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