Julius Chapiro MD, Presenter: Nothing to Disclose

Rafael Duran MD, Abstract Co-Author: Nothing to Disclose

MingDe Lin PhD, Abstract Co-Author: Employee, Koninklijke Philips NV

Ruediger Egbert Schernthaner MD, Abstract Co-Author: Nothing to Disclose

Carol Thompson, Abstract Co-Author: Nothing to Disclose

Jean-Francois H. Geschwind MD, Abstract Co-Author: Consultant, BTG International Ltd Consultant, Bayer AG Consultant, Guerbet SA Consultant, Nordion, Inc Grant, BTG International Ltd Grant, F. Hoffmann-La Roche Ltd Grant, Bayer AG Grant, Koninklijke Philips NV Grant, Nordion, Inc Grant, ContextVision AB Grant, CeloNova BioSciences, Inc Founder, PreScience Labs, LLC CEO, PreScience Labs, LLC

The most commonly used staging systems for hepatocellular carcinoma (HCC) (e.g. BCLC, CLIP) use the largest lesion diameter as the leading imaging biomarker for tumor status. This study tested and compared the prognostic value of lesion diameter, volume and enhancement on baseline MR imaging to predict overall survival (OS) in patients with unresectable HCC treated with transarterial chemoembolization (TACE).

This retrospective analysis included 79 patients with unresectable HCC who were to receive their first TACE. Baseline arterial-phase contrast enhanced MRI (ceMRI) was used to measure the overall and enhancing tumor diameters. In addition, a segmentation-based 3D quantification of the overall and enhancing tumor volumes was performed in each patient (see Figure 1). Numeric cutoff values (5cm for diameters and 65cm3 for volumes) were used to stratify the patient cohort in two groups for each method. Survival was evaluated using Kaplan-Meier analysis and compared using Cox proportional hazard ratios (HR) after uni- and multivariate analysis. 

Median OS of the entire population was 16.4 months (95% CI, 11.4-21.5). The stratification according to overall or enhancing tumor diameters did not result in a statistically significant separation of the survival curves (HR 1.4 [95% CI, 0.7-2.5]; P=0.234 and HR 1.6 [95% CI, 0.9-2.8]; P=0.080, respectively). The stratification according to overall or enhancing tumor volume achieved statistical significance (HR, 1.8 [95% CI, 0.9-3.4]; P=0.022 and HR, 1.8 [1.1-3.1]; P=0.017, respectively). Patients with enhancing tumor volumes <65cm3 survived significantly longer than patients with larger enhancing tumor volumes (P=0.013; 29.7 months [95% CI, 14.5-44.9] vs. 15.0 months [95% CI, 10.4-19.6], respectively). 

As opposed to tumor diameter which currently is the most commonly used staging marker, volumetric assessment of lesion size and enhancement on baseline ceMRI is strongly associated with patient survival after TACE. 

The use of volumetry-based thresholds as staging biomarkers might lead to more accurate prognostic discriminators in future staging systems. 

Chapiro, J, Duran, R, Lin, M, Schernthaner, R, Thompson, C, Geschwind, J, Identifying New Staging Markers for HCC before TACE: Which Lesion Parameter on Baseline MR Imaging Is the Ideal Prognostic Marker?.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14006846.html