Maxime Ronot MD, Presenter: Nothing to Disclose

Amedeo Sciarra, Abstract Co-Author: Nothing to Disclose

Luca Di Tommaso, Abstract Co-Author: Nothing to Disclose

carlotta raschioni, Abstract Co-Author: Nothing to Disclose

Pierre Bedossa, Abstract Co-Author: Nothing to Disclose

Massimo Roncalli, Abstract Co-Author: Nothing to Disclose

Valerie Vilgrain MD, Abstract Co-Author: Nothing to Disclose

Valerie Paradis MD, Abstract Co-Author: Nothing to Disclose

1) To identify tumoral tissue markers as potential predictors of resistance to transarterial chemoembolization (TACE) in hepatocellular carcinoma (HCC), 2) to provide a simple scoring system to be applied on pre-TACE HCC biopsy, and 3) to validate the score.

Inclusion criteria were patients with HCC who received TACE and who had pre-TACE biopsy of the tumor from 2005 to 2010. Two groups of patients were analyzed: 1) a study group composed of resected patients used to build the scoring system, and 2) a validation group of non-resected patients whom tumor response was evaluated at imaging. Resistance to TACE was defined as residual tumor >50% on resected specimen in the former and as non-complete tumor response according to mRECIST in the latter. In the study group, tumor size, the immunohistochemical expression of markers related to hypoxia and angiogenesis (HIF1-α, VEGF and CD34), apoptosis (CA9), stemness phenotype (Nestin), and epithelial-mesenchymal transition (Vimentin, E-Cadherin, Twist) were analyzed. Variables associated with TACE resistance were entered as candidate variables into a stepwise logistic regression model in order to build a TACE-resistance prediction score. This score was then validated on the validation group. 

The study study was composed of 108 lesions from 41 cirrhotic patients (39 males (95%), mean age 58.5±8). Overall 45/108 (44%) HCC were classified as TACE-resistant. Of these, 33 (73%) had a diameter ≤ 3 cm, 28 (62%) showed a high microvessel density (CD34 staining) and 40 (89%) low VEGF expression (p<0.05). The association of these three parameters (small size, ↑CD34 and ↓VEGF) in a weighted score was able to predict TACE-resistance with 87% accuracy, 87% sensitivity and 88% specificity. The validation set was composed of 28 HCC patients (23 males (82%), mean age 65,5±10). The score was predictive of TACE-resistance with 75% accuracy, 74% sensitivity, 80% specificity. 

Combination of VEGF and CD34 staining performed on pre-TACE biopsy together with the tumor size may be useful for the prediction of TACE-resistance in HCC.

Patients with HCC treated with TACE may benefit from a tumoral morpho-phenotypic analysis performed on pre-treatment biopsy

Ronot, M, Sciarra, A, Di Tommaso, L, raschioni, c, Bedossa, P, Roncalli, M, Vilgrain, V, Paradis, V, Hepatocellular Carcinoma Treated by Transarterial Chemoembolization: Prediction of Treatment Failure Using Tumoral Morpho-phenotypic Features on Pre-treatment Biopsy  .  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14003702.html