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. 2022 Sep-Oct;36(5):2332-2341.
doi: 10.21873/invivo.12964.

Volumetric Analysis of Hepatocellular Carcinoma After Transarterial Chemoembolization and its Impact on Overall Survival

Monika Hajkova  1 , Tomas Andrasina  2 , Petra Ovesna  3 , Tomas Rohan  1 , Marek Dostal  4 , Vlastimil Valek  1 , Lenka Ostrizkova  5 , Stepan Tucek  5 , Jiri Sedo  6 , Igor Kiss  6
Affiliations

Volumetric Analysis of Hepatocellular Carcinoma After Transarterial Chemoembolization and its Impact on Overall Survival

Monika Hajkova et al. In Vivo. 2022 Sep-Oct.

Abstract

Background/aim: To evaluate the prognostic value of Response Evaluation Criteria In Solid Tumors (RECIST), modified RECIST and volumetric analysis in patients with hepatocellular carcinoma (HCC) treated by transarterial chemoembolization (TACE).

Patients and methods: This single-center prospective cohort study included a total of 61 patients with HCC treated by transarterial chemoembolization (TACE). The response of TACE was evaluated on preprocedural and postprocedural CT by two radiologists using RECIST/mRECIST and volumetric response to treatment. Each response assessment method was used to classify the response as progressive disease, stable disease, partial response and complete response. Kaplan-Meier analysis with log-rank test was performed for each method to evaluate its ability to help predict overall survival and progression free survival. Interobserver variability and reproducibility was determined by the Pearson and Spearman correlation coefficients.

Results: The median overall survival was 17.1 months and the median progression-free survival was 11.1 months. Volumetric assessment was proved to be a prognostic factor for overall survival (p<0.01) and progression-free survival (p<0.001), contrasting with RECIST and mRECIST. All three methods featured very small interobserver variability (p<0.001 for Pearson and Spearman correlation coefficients). The patients classified as having stable disease had a 3.8-fold higher risk of death than the patients classified as having a complete/partial response (HR=3.82; 95% Confidence Interval (CI)=1.32-11.02; p=0.013) and a 4.5-fold higher risk of progression (HR=4.46; 95% CI=1.72-11.61; p=0.002).

Conclusion: The prognostic value of volumetric analysis in patients with HCC treated by TACE appears to be superior to RECIST and mRECIST, with a real impact in everyday practice.

Keywords: Hepatocellular carcinoma; RECIST; mRECIST; transarterial chemoembolization; volumetric analysis.

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Conflict of interest statement

The Authors report no conflicts of interest in relation to this study.

Figures

Figure 1
Figure 1. Hepatocellular carcinoma after a single session of TACE. (A) CT scan 3 weeks after the procedure. (B) Measurement using volumetric analysis. (C) Measurement using RECIST (red arrow) and mRECIST (blue arrow).
Figure 2
Figure 2. Bland and Altman plots showing the means and differences between measurement 1 and 2.
Figure 3
Figure 3. Kaplan Meier plots of overall survival (OS). OS of patients with HCC after TACE with p-value of the log-rank test according to RECIST (p=0.142), mRECIST (p=0.505) and volumetric analysis (p=0.005). The green line corresponds to CR+PR, the blue line corresponds to SD, the red line corresponds to PD. 95% confidence interval is presented by the dashed line.
Figure 4
Figure 4. Kaplan Meier plots of progression free survival (PFS). PFS of patients with hepatocellular carcinoma after TACE with p-value of the logrank test according to RECIST (p=0.135), mRECIST (p=0.197) and volumetric analysis (p<0.001). The green line corresponds to CR+PR, the blue line corresponds to SD, the red line corresponds to PD.
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