Imaging Predictors of Survival in Patients with Single Small Hepatocellular Carcinoma Treated with Transarterial Chemoembolization

Abstract

Objective: Clinical outcomes of patients who undergo transarterial chemoembolization (TACE) for single small hepatocellular carcinoma (HCC) are not consistent, and may differ based on certain imaging findings. This retrospective study was aimed at determining the efficacy of pre-TACE CT or MR imaging findings in predicting survival outcomes in patients with small HCC upon being treated with TACE. Besides, the study proposed to build a risk prediction model for these patients. Materials and Methods: Altogether, 750 patients with functionally good hepatic reserve who received TACE as the first-line treatment for single small HCC between 2004 and 2014 were included in the study. These patients were randomly assigned into training (n = 525) and validation (n = 225) sets. Results: According to the results of a multivariable Cox analysis, three pre-TACE imaging findings (tumor margin, tumor location, enhancement pattern) and two clinical factors (age, serum albumin level) were selected and scored to create predictive models for overall, local tumor progression (LTP)-free, and progression-free survival in the training set. The median overall survival time in the validation set were 137.5 months, 76.1 months, and 44.0 months for low-, intermediate-, and high-risk groups, respectively (p < 0.001). Time-dependent receiver operating characteristic curves of the predictive models for overall, LTP-free, and progression-free survival applied to the validation cohort showed acceptable areas under the curve values (0.734, 0.802, and 0.775 for overall survival; 0.738, 0.789, and 0.791 for LTP-free survival; and 0.671, 0.733, and 0.694 for progression-free survival at 3, 5, and 10 years, respectively). Conclusion: Pre-TACE CT or MR imaging findings could predict survival outcomes in patients with small HCC upon treatment with TACE. Our predictive models including three imaging predictors could be helpful in prognostication, identification, and selection of suitable candidates for TACE in patients with single small HCC.

Chemoembolization for Single Large Hepatocellular Carcinoma with Preserved Liver Function: Analysis of Factors Predicting Clinical Outcomes in a 302 Patient Cohort

“…Our study is different from others since previous studies investigating TACE for single large HCC only included huge HCCs (>10 cm) [ 20 , 21 ] or performed subgroup comparison of single large HCCs with heterogenous BCLC A or B HCCs [ 22 ]. Furthermore, previous risk prediction models were generated for inhomogeneous groups [ 10 , 23 , 24 ] or single small HCC (≤3 cm) [ 25 ].…”

Liver MRI and clinical findings to predict response after drug eluting bead transarterial chemoembolization in hepatocellular carcinoma

“…The tumor location was classified into two categories: peripheral or central. Central location was defined as a tumor located within 0.5 cm of the first or second branches of the portal vein, or a tumor located at least 3 cm away from the liver capsule 14 . In the case of multiple tumors, only when all tumors were not in the central location, it was regarded as a peripheral tumor location.…”

“…Therefore, predicting the response to TACE based on pretreatment MRIs could be used for establishing a treatment strategy. Recently, several studies have investigated pretreatment imaging findings, including MRIs, which may be predictors of treatment response or overall outcomes in conventional TACE 14 – 18 . However, there are fewer studies about DEB-TACE than conventional TACE.…”

How to Clearly and Accurately Report Odds Ratio and Hazard Ratio in Diagnostic Research Studies?

“…When 28 original research studies reporting HR published in the Korean Journal of Radiology in 2020–2021 [ 11 15 32 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 ] were evaluated against a rigorous standard, 96.4% (27/28) explicitly defined the events for HR, 48.1% (13/27) unmistakably described the reference category for HR calculation for categorical variables, and only 50% (10/20) clearly described the one-unit amount for HR for continuous variables. Therefore, further improvements are required.…”