Impact of cone-beam computed tomography with automated feeder detection software on the survival outcome of patients with hepatocellular carcinoma during treatment with conventional transarterial chemoembolization

Abstract

Background: Inoperable hepatocellular carcinoma (HCC) is treated by conventional transarterial chemoembolization (cTACE) using cone-beam computed tomography (CBCT) or digital subtraction angiography (DSA). We compared patient survival outcomes between CBCT-cTACE with automated tumor-feeder detection (AFD) software and DSA-cTACE alone in inoperable HCC patients.

Methods: We reviewed the data of 337 HCC patients treated by CBCT-cTACE or DSA-cTACE between January 2015 and December 2019. Treatment response, progression-free survival (PFS), overall survival (OS), and complications between the CBCT-cTACE and DSA-cTACE groups were compared. Univariate and multivariate logistic regression analyses examined the potential prognostic factors affecting survival after chemoembolization.

Results: Tumor response rates in complete response, partial response, and stable disease at 1 month were 67%, 28%, and 4% in the CBCT-cTACE group and 22%, 48%, and 9% in the DSA-cTACE group, respectively. OS rates of patients in the CBCT-cTACE versus DSA-cTACE groups were 87% versus 54%, 44% versus 15%, and 34% versus 7% at 1, 3, and 5 years, respectively. The CBCT-cTACE group had significantly improved PFS (p < 0.001) and OS (p < 0.001). Multivariate analysis showed that CBCT with AFD software was an independent factor associated with longer OS (hazard ratio, 0.38; p < 0.001).

Conclusions: Compared with conventional DSA, combining selective cTACE with CBCT and AFD software leads to better tumor response and prolongs OS in patients with inoperable HCC.

Keywords: Cone-beam computed tomography; Hepatocellular carcinoma; Software tools; Survival rate; Therapeutic chemoembolization.

Fig. 1

Cone-beam computed tomography (CBCT) with automated tumor-feeder detection software assisted conventional transarterial chemoembolization (cTACE). A Gadoxetic acid-enhanced MRI in the arterial phase in a 58-year-old male with chronic viral hepatitis-B cirrhosis showing two hyperenhancing nodules (arrows) in liver segment 5. Hepatobiliary phase imaging at 20 min after injection shows two hypointense nodules (arrows) against the background of enhancing liver parenchyma, which may indicate HCC. B‒C Dual-phase CBCT during hepatic arteriography could depict all tumors (arrows) with corona enhancement (arrowheads). D Common hepatic arteriogram showed two faint tumor stains (arrows). However, the tumor-feeders were unclear. E Automated tumor-feeder detection software identified the feeders (arrowhead) of each tumor (arrows). F Tumor-feeder (arrowhead) was selectively embolized during cTACE. Complete tumor staining (arrows) was demonstrated from spot image on digital subtraction angiography. G‒H CBCT immediately after cTACE showed dense iodized oil accumulation in all tumors (arrows) with a sufficient safety margin (arrowheads). I Enhanced CT performed 1 year after selective cTACE showed dense iodized oil accumulation in all tumors without tumor recurrence

Fig. 2

Cumulative overall survival of HCC treated with selective conventional transarterial chemoembolization (cTACE) with cone-beam computed tomography (CBCT) and automated tumor-feeder detection software assistance (CBCT-cTACE group) or with digital subtraction angiography (DSA-cTACE group)