Radiographic Response to Locoregional Therapy in Hepatocellular Carcinoma Predicts Patient Survival Times

Abstract

Background & Aims It is not clear whether survival times of patients with hepatocellular carcinoma (HCC) are associated with their response to therapy. We analyzed the association between tumor response and survival times of patients with HCC who were treated with locoregional therapies (LRTs; chemoembolization and radioembolization). Methods Patients received LRTs over a 9-year period (n=463). Patients with metastases, portal venous thrombosis, or who had received transplants were excluded; 159 patients with Child-Pugh≤B7 were analyzed. Response (based on European Association for Study of the Liver [EASL] or World Health Organization [WHO] criteria) was associated with survival times using the landmark, risk-of-death, and Mantel-Byar methodologies. In a subanalysis, survival times of responders were compared to those of patients with stable disease (SD) and progressive disease (PD). Results Based on 6-month data, in landmark analysis, responders survived longer than nonresponders (based on EASL but not WHO criteria: P=0.002 and 0.0694). The risk of death was also lower for responders (based on EASL but not WHO criteria: P=0.0463 and 0.707). Landmark analysis of 12-month data showed that responders survived longer than nonresponders (P=<0.0001 and 0.004, based on EASL and WHO criteria, respectively). The risk of death was lower for responders (P=0.0132 and 0.010, based on EASL and WHO criteria, respectively). By the Mantel-Byar method, responders had longer survival than nonresponders, based on EASL criteria (P<0.0001; P=0.596 with WHO criteria). In the subanalysis, responders lived longer than patients with SD or PD. Conclusion Radiographic response to LRTs predicts survival time. EASL criteria for response more consistently predicted survival times than WHO criteria. The goal of LRT should be to achieve a radiologic response, rather than to stabilize disease.

Personalized Dosimetry with Intensification Using 90Y-Loaded Glass Microsphere Radioembolization Induces Prolonged Overall Survival in Hepatocellular Carcinoma Patients with Portal Vein Thrombosis

“…Once again, we observed that TD clearly affected the response rate, as previously described (10)(11)(12). Achieving high response rates is a crucial goal that has been associated with extended OS (7,18), especially in PVT patients, with responders exhibiting a 3-y survival rate of 25%, compared with only 4.4% for nonresponders (P 5 0.02) (7). In line with previous findings (11,12), we saw no evident correlation between response and size, and we observed a high response rate (91%) for patients with lesions measuring 10 cm or more.…”

EASL- and mRECIST-Evaluated Responses to Combination Therapy of Sorafenib with Transarterial Chemoembolization Predict Survival in Patients with Hepatocellular Carcinoma

“…However, previous studies of hepatocellular carcinoma have not determined the minimal interval of time after treatment required to accurately assess response (12,(14)(15)(16). In fact, most studies have indicated that the best response to locoregional or sorafenib treatment is the patient's final response.…”

“…Second, as previous studies have shown the standard method of comparing responders with nonresponders without considering the time variable may lead to biased estimates of the survival distributions and misleading conclusions (25). Memon and colleagues have recently used three methods (landmark, risk-of-death, and Mantel-Byar) to correct for analyses of responders and nonresponders (which are plagued by guarantee-time bias) and found that the EASL response at 6 and 12 months after locoregional therapy could predict survival times (12). We sought to determine the earliest time point at which the response to combination therapy is associated with a favorable prognostic value.…”

“…Both proposed response assessment systems focus on changes in the viable tumor burden, which is ascertained using dynamic imaging techniques to identify the contrast-enhanced areas. Several studies have shown that in patients treated with transarterial chemoembolization (TACE) or sorafenib monotherapy, survival correlates more closely with the tumor response defined by these new criteria than with the tumor response defined by RECIST (12)(13)(14)(15)(16). However, few studies have defined specific early time points at which the assessment of treatment response has potential prognostic value.…”

Toward a standardized system for hepatocellular carcinoma diagnosis using computed tomography and MRI

“…The majority of such guidelines endorse ultrasound (US) for screening and surveillance. Contrastenhanced CT or contrast-enhanced MRI are recommended to more definitively evaluate US-detected lesions, detect HCC missed by US in at-risk patients [1][2][3], establish the noninvasive diagnosis of HCC [1][2][3][4], stage tumor extent [4,10,11], assess the severity of underlying liver disease and portal hypertension [12], inform treatment decisions for HCC [11], assess therapeutic response [9,10,13,14] and determine eligibility and priority for liver transplantation [9,13,[15][16][17][18]. In addition, in many North American centers, CT and MRI are used for screening and surveillance and not just for evaluation of patients with positive findings at US surveillance.…”