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Multicenter Study
. 2018 Feb 20;18(1):211.
doi: 10.1186/s12885-018-4120-4.

Preliminary qualification of a novel, hypoxic-based radiologic signature for trans-arterial chemoembolization in hepatocellular carcinoma

David J Pinato  1 , Madhava Pai  2 , Isabella Reccia  2 , Markand Patel  3 , Alexandros Giakoustidis  3 , Georgios Karamanakos  2 , Azelea Rushd  1 , Shiraz Jamshaid  1 , Alberto Oldani  4 , Glenda Grossi  5 , Mario Pirisi  5   6 , Paul Tait  7 , Rohini Sharma  8
Affiliations
Multicenter Study

Preliminary qualification of a novel, hypoxic-based radiologic signature for trans-arterial chemoembolization in hepatocellular carcinoma

David J Pinato et al. BMC Cancer. .

Abstract

Background: Survival advantage following trans-arterial chemoembolization (TACE) is variable in patients with hepatocellular carcinoma (HCC). We combined pre-TACE radiologic features to derive a novel prognostic signature in HCC.

Methods: A multi-institutional dataset of 98 patients was generated from two retrospective cohorts from United Kingdom (65%) and Italy (36%). The prognostic impact of a number baseline imaging parameters was assessed and factors significant on univariate analysis were combined to create a novel radiologic signature on multivariable analyses predictive of overall survival (OS) following TACE.

Results: Median OS was 15.4 months. Tumour size > 7 cm (p < 0.001), intra-tumour necrosis (ITN) (p = 0.02) and arterial ectatic neovascularisation (AEN) (p = 0.03) emerged as individual prognostic factors together with radiologic response (p < 0.001) and elevated alpha-fetoprotein (AFP) (p = 0.01). Combination of tumour size > 7 cm, ITN and AEN identified patients with poor prognosis (p < 0.001).

Conclusions: We identified a coherent signature based on commonly available imaging biomarkers likely to be reflective of differential patterns of relative hypoxia and neovascularisation. Large tumours displaying AEN and ITN are characterised by a shorter survival after TACE.

Keywords: Hepatocellular carcinoma; Prognosis; Prognostic index; Survival; Transarterial chemoembolisation.

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Conflict of interest statement

Ethics approval and consent to participate

Granted by local ethics committee, Imperial College Healthcare NHS Trust.

Consent for publication

Not applicable.

Competing interests

All the authors have read the journal’s policy on conflicts of interest and have none to declare.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Representative triphasic CT sequences of imaging biomarkers are illustrated: intra-tumour necrosis (ITN) (a), presence of peri-tumour capsule (PTC) (b), tumour size >7cm with portal vein involvement (PVI) (c), arterial ectatic neovascularisation (AEN) (d) and artero-venous shunting (AVS) identified on a pre-treatment hepatic arterial angiogram (e)
Fig. 2
Fig. 2
Kaplan-Meier curves showing the relationship between overall survival and the newly qualified radiologic signature in patients treated with TACE
See this image and copyright information in PMC

References

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