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European Radiology

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01-08-2019 | Gastrointestinal

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

Authors: Hasmik Koulakian, Wassim Allaham, Valérie Vilgrain, Maxime Ronot

Published in: European Radiology | Issue 8/2019

Abstract

Objectives

To evaluate the value of CT attenuation to assess the response to sorafenib in infiltrative/endovascular non-measurable advanced hepatocellular carcinoma (HCC).

Methods

From 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.

Results

Forty 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 4 ± 1 months (95% CI: 2.1–5.9), with estimated OS rates at 6, 12, and 24 months 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.

Conclusion

Despite 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

• Attenuation of both tumors and tumor-in-vein decreases after sorafenib.

• Attenuation decrease is more marked in the tumor-in-vein than in the tumor.

• Attenuation decrease is not associated with longer overall survival.

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Title: Non-measurable infiltrative HCC: is post-contrast attenuation on CT a sign of tumor response?
Authors: Hasmik Koulakian
Wassim Allaham
Valérie Vilgrain
Maxime Ronot
Publication date: 01-08-2019
Publisher: Springer Berlin Heidelberg
Published in: European Radiology / Issue 8/2019
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-018-5805-4

At a glance: The STEP trials

Springer Medicine

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

Abstract

Objectives

Methods

Results

Conclusion

Key Points

At a glance: The STEP trials

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusion

Key Points

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