Prognostic value of splenic volume in hepatocellular carcinoma patients receiving transarterial chemoembolization

Dai, Haitao; Chen, Bin; Tang, Keyu; Zhang, Guiyuan; Wen, Chunyong; Xiang, Xianhong; Yang, Jing; Guo, Yan; Lin, Run; Huang, Yonghui

doi:10.21037/jgo-21-226

Cited by 3 publications

(5 citation statements)

References 33 publications

(47 reference statements)

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“…First, it was a single-center, retrospective study. However, the sample size was distinctly larger than that included in the previous study on this topic [ 12 ]. Additionally, our dataset was well investigated and we only included patients with complete clinical, laboratory, and imaging data.…”

Section: Discussionmentioning

confidence: 95%

“…The literature is scarce regarding the prognostic role of splenic volume for patients with HCC undergoing TACE. To date, only one recent study by Dai et al showed that splenic volume was correlated to the Child-Pugh classification and OS [ 12 ]. The mean splenic volume of the 67 patients in that study was 300 ml, prior to TACE.…”

Section: Discussionmentioning

confidence: 99%

“…Accordingly, the splenic volume has been identified as a highly sensitive prognostic parameter for patients with HCC undergoing resection or tumor ablation [ 9 – 11 ]. In an initial study in patients with HCC that underwent transarterial chemoembolization (TACE), splenic volume was recently identified as a relevant prognostic factor [ 12 ]. Progression-free survival and hepatic decompensation were not investigated.…”

Section: Introductionmentioning

confidence: 99%

“…Progression-free survival and hepatic decompensation were not investigated. Moreover, the sample size was small and spleen volume was assessed manually [ 12 ]. Manual splenic volume assessments on cross-sectional computed tomography (CT) images is a time-consuming task with a high risk of interrater variance [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

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Fully automated AI-based splenic segmentation for predicting survival and estimating the risk of hepatic decompensation in TACE patients with HCC

et al. 2022

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Objectives Splenic volume (SV) was proposed as a relevant prognostic factor for patients with hepatocellular carcinoma (HCC). We trained a deep-learning algorithm to fully automatically assess SV based on computed tomography (CT) scans. Then, we investigated SV as a prognostic factor for patients with HCC undergoing transarterial chemoembolization (TACE). Methods This retrospective study included 327 treatment-naïve patients with HCC undergoing initial TACE at our tertiary care center between 2010 and 2020. A convolutional neural network was trained and validated on the first 100 consecutive cases for spleen segmentation. Then, we used the algorithm to evaluate SV in all 327 patients. Subsequently, we evaluated correlations between SV and survival as well as the risk of hepatic decompensation during TACE. Results The algorithm showed Sørensen Dice Scores of 0.96 during both training and validation. In the remaining 227 patients assessed with the algorithm, spleen segmentation was visually approved in 223 patients (98.2%) and failed in four patients (1.8%), which required manual re-assessments. Mean SV was 551 ml. Survival was significantly lower in patients with high SV (10.9 months), compared to low SV (22.0 months, p = 0.001). In contrast, overall survival was not significantly predicted by axial and craniocaudal spleen diameter. Furthermore, patients with a hepatic decompensation after TACE had significantly higher SV (p < 0.001). Conclusion Automated SV assessments showed superior survival predictions in patients with HCC undergoing TACE compared to two-dimensional spleen size estimates and identified patients at risk of hepatic decompensation. Thus, SV could serve as an automatically available, currently underappreciated imaging biomarker. Key Points • Splenic volume is a relevant prognostic factor for prediction of survival in patients with HCC undergoing TACE, and should be preferred over two-dimensional surrogates for splenic size. • Besides overall survival, progression-free survival and hepatic decompensation were significantly associated with splenic volume, making splenic volume a currently underappreciated prognostic factor prior to TACE. • Splenic volume can be fully automatically assessed using deep-learning methods; thus, it is a promising imaging biomarker easily integrable into daily radiological routine.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Fully automated AI-based splenic segmentation for predicting survival and estimating the risk of hepatic decompensation in TACE patients with HCC

et al. 2022

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“…Spleen volume, with and without adjustment to future remnant liver volume, BSA or platelets, has also been correlated with PHLF and survival [121][122][123][124][125][126][127][128][129]. The use of liver and spleen volumetry has also been studied in predicting outcomes following locoregional treatments such as thermal ablation, transarterial chemoembolisation and transarterial radioembolisation and following systemic therapy [130][131][132][133][134][135][136]. A detailed description of findings from these studies is beyond the scope of this review due to the differences and complexity of such treatments.…”

Section: Hepatocellular Carcinoma-related Outcomesmentioning

confidence: 99%

The impact of hepatic and splenic volumetric assessment in imaging for chronic liver disease: a narrative review

Kutaiba,

Chung,

Goodwin

et al. 2024

Insights Imaging

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Chronic liver disease is responsible for significant morbidity and mortality worldwide. Abdominal computed tomography (CT) and magnetic resonance imaging (MRI) can fully visualise the liver and adjacent structures in the upper abdomen providing a reproducible assessment of the liver and biliary system and can detect features of portal hypertension. Subjective interpretation of CT and MRI in the assessment of liver parenchyma for early and advanced stages of fibrosis (pre-cirrhosis), as well as severity of portal hypertension, is limited. Quantitative and reproducible measurements of hepatic and splenic volumes have been shown to correlate with fibrosis staging, clinical outcomes, and mortality. In this review, we will explore the role of volumetric measurements in relation to diagnosis, assessment of severity and prediction of outcomes in chronic liver disease patients. We conclude that volumetric analysis of the liver and spleen can provide important information in such patients, has the potential to stratify patients’ stage of hepatic fibrosis and disease severity, and can provide critical prognostic information. Critical relevance statement This review highlights the role of volumetric measurements of the liver and spleen using CT and MRI in relation to diagnosis, assessment of severity, and prediction of outcomes in chronic liver disease patients. Key Points Volumetry of the liver and spleen using CT and MRI correlates with hepatic fibrosis stages and cirrhosis. Volumetric measurements correlate with chronic liver disease outcomes. Fully automated methods for volumetry are required for implementation into routine clinical practice. Graphical Abstract

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Ferritin Nanocaged Doxorubicin Potentiates Chemo‐Immunotherapy against Hepatocellular Carcinoma via Immunogenic Cell Death

et al. 2022

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Although immunotherapy of hepatocellular carcinoma using immune checkpoint inhibitors has achieved certain success, only a subset of patients benefits from this therapeutic strategy. The combination of immunostimulatory chemotherapeutics represents a promising strategy to enhance the effectiveness of immunotherapy. However, it is hampered by the poor delivery of conventional chemotherapeutics. Here, it is shown that H‐ferritin nanocages loaded with doxorubicin (DOX@HFn) show potent chemo‐immunotherapy in hepatocellular carcinoma tumor models. DOX@HFn is constructed with uniform size, high stability, favorable drug loading, and intracellular acidity‐driven drug release. The receptor‐mediated targeting of DOX@HFn to liver cancer cells promote cellular uptake and tumor penetration in vitro and in vivo. DOX@HFn triggers immunogenic cell death to tumor cells and promotes the subsequent activation and maturation of dendritic cells. In vivo studies in H22 subcutaneous hepatoma demonstrate that DOX@HFn significantly inhibits the tumor growth with >30% tumors completely eliminated, while alleviating the systemic toxicity of free DOX. DOX@HFn also exhibits robust antitumor immune response and tumoricidal effect in a more aggressive Hepa1‐6 orthotopic liver tumor model, which is confirmed by the in situ magnetic resonance imaging and transcriptome sequencing. This study provides a facile and robust strategy to improve therapeutic efficacy of liver cancer.

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Prognostic value of splenic volume in hepatocellular carcinoma patients receiving transarterial chemoembolization

Cited by 3 publications

References 33 publications

Fully automated AI-based splenic segmentation for predicting survival and estimating the risk of hepatic decompensation in TACE patients with HCC

Fully automated AI-based splenic segmentation for predicting survival and estimating the risk of hepatic decompensation in TACE patients with HCC

The impact of hepatic and splenic volumetric assessment in imaging for chronic liver disease: a narrative review

Ferritin Nanocaged Doxorubicin Potentiates Chemo‐Immunotherapy against Hepatocellular Carcinoma via Immunogenic Cell Death

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