Prognostic value of baseline imaging and clinical features in patients with advanced hepatocellular carcinoma

Summary Aims To investigate the prognostic value of baseline imaging features for overall survival (OS) and liver decompensation (LD) in patients with hepatocellular carcinoma (HCC). Design Patients with advanced HCC from the SORAMIC trial were evaluated in this post hoc analysis. Several radiological imaging features were collected from baseline computed tomography (CT) and magnetic resonance imaging (MRI) imaging, besides clinical values. The prognostic value of these features for OS and LD (grade 2 bilirubin increase) was quantified with univariate Cox proportional hazard models and multivariate Least Absolute Shrinkage and Selection Operator (LASSO) regression. Results Three hundred and seventy-six patients were included in this study. The treatment arm was not correlated with OS. LASSO showed satellite lesions, atypical HCC, peritumoral arterial enhancement, larger tumour size, higher albumin–bilirubin (ALBI) score, liver–spleen ratio <1.5, ascites, pleural effusion and higher bilirubin values were predictors of worse OS, and higher relative liver enhancement, smooth margin and capsule were associated with better OS. LASSO analysis for LD showed satellite lesions, peritumoral hypointensity in hepatobiliary phase, high ALBI score, higher bilirubin values and ascites were predictors of LD, while randomisation to sorafenib arm was associated with lower LD. Conclusions Imaging features showing aggressive tumour biology and poor liver function, in addition to clinical parameters, can serve as imaging biomarkers for OS and LD in patients receiving sorafenib and selective internal radiation therapy for HCC.

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The prognostic value of inflammation-based scores in advanced hepatocellular carcinoma patients prior to treatment with sorafenib

Oncotarget ◽

10.18632/oncotarget.21401 ◽

2017 ◽

Vol 8 (56) ◽

pp. 95853-95864 ◽

Cited By ~ 5

Author(s):

Guillaume Conroy ◽

Julia Salleron ◽

Arthur Belle ◽

Mouni Bensenane ◽

Abdelbasset Nani ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Prognostic Value ◽

Advanced Hepatocellular Carcinoma

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Magnetic resonance imaging of the cirrhotic liver: diagnosis of hepatocellular carcinoma and evaluation of response to treatment – Part 2

Radiologia Brasileira ◽

10.1590/0100-3984.2015.0140 ◽

2017 ◽

Vol 50 (2) ◽

pp. 115-125 ◽

Cited By ~ 8

Author(s):

Miguel Ramalho ◽

António P. Matos ◽

Mamdoh AlObaidy ◽

Fernanda Velloni ◽

Ersan Altun ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Hepatocellular Carcinoma ◽

Magnetic Resonance ◽

Diagnostic Algorithm ◽

Response To Treatment ◽

Locoregional Therapy ◽

Liver Imaging ◽

Imaging Features ◽

Resonance Imaging ◽

Magnetic Resonance Imaging Mri

Abstract In the second part of this review, we will describe the ancillary imaging features of hepatocellular carcinoma (HCC) that can be seen on standard magnetic resonance imaging (MRI) protocol, and on novel and emerging protocols such as diffusion weighted imaging and utilization of hepatocyte-specific/hepatobiliary contrast agent. We will also describe the morphologic sub-types of HCC, and give a simplified non-invasive diagnostic algorithm for HCC, followed by a brief description of the liver imaging reporting and data system (LI-RADS), and MRI assessment of tumor response following locoregional therapy.

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Prediction of Microvascular Invasion in Hepatocellular Carcinoma: Preoperative Gd-EOB-DTPA-Dynamic Enhanced MRI and Histopathological Correlation

Contrast Media & Molecular Imaging ◽

10.1155/2018/9674565 ◽

2018 ◽

Vol 2018 ◽

pp. 1-9 ◽

Cited By ~ 10

Author(s):

Mengqi Huang ◽

Bing Liao ◽

Ping Xu ◽

Huasong Cai ◽

Kun Huang ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Prediction Model ◽

Tumor Size ◽

Univariate Analysis ◽

Microvascular Invasion ◽

Arterial Phase ◽

Hepatobiliary Phase ◽

Imaging Features ◽

Tumor Margin ◽

Enhanced Mri

Objective. To investigate the imaging features observed in preoperative Gd-EOB-DTPA-dynamic enhanced MRI and correlated with the presence of microvascular invasion (MVI) in hepatocellular carcinoma (HCC) patients. Methods. 66 HCCs in 60 patients with preoperative Gd-EOB-DTPA-dynamic enhanced MRI were retrospectively analyzed. Features including tumor size, signal homogeneity, tumor capsule, tumor margin, peritumor enhancement during mid-arterial phase, peritumor hypointensity during hepatobiliary phase, signal intensity ratio on DWI and apparent diffusion coefficients (ADC), T1 relaxation times, and the reduction rate between pre- and postcontrast enhancement images were assessed. Correlation between these features and histopathological presence of MVI was analyzed to establish a prediction model. Results. Histopathology confirmed that MVI were observed in 17 of 66 HCCs. Univariate analysis showed tumor size (p=0.003), margin (p=0.013), peritumor enhancement (p=0.001), and hypointensity during hepatobiliary phase (p=0.004) were associated with MVI. A multiple logistic regression model was established, which showed tumor size, margin, and peritumor enhancement were combined predictors for the presence of MVI (α=0.1). R2 of this prediction model was 0.353, and the sensitivity and specificity were 52.9% and 93.0%, respectively. Conclusion. Large tumor size, irregular tumor margin, and peritumor enhancement in preoperative Gd-EOB-DTPA-dynamic enhanced MRI can predict the presence of MVI in HCC.

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Imaging approaches to assess mechanism-of-action and response in patients with advanced hepatocellular carcinoma treated with the novel oncolytic poxvirus JX-594.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.4_suppl.210 ◽

2013 ◽

Vol 31 (4_suppl) ◽

pp. 210-210

Author(s):

Richard H. Patt ◽

David H. Kirn ◽

Caroline Breitbach ◽

James M. Burke ◽

Riccardo Lencioni

Keyword(s):

Hepatocellular Carcinoma ◽

Oncolytic Virus ◽

Advanced Hepatocellular Carcinoma ◽

The Novel ◽

Mri Imaging ◽

Vascular Disruption ◽

Imaging Results ◽

Anti Cancer ◽

Mri Scans ◽

Tumor Measurements

210 Background: The novel oncolytic virus JX-595 has demonstrated anti-cancer mechanisms of action, as defined in preclinical models, which includes cytolysis, intra-tumoral vascular disruption, and immune-mediated tumor targeting. Methods: To determine whether mechanism(s) of action (MOA) of the novel anti-cancer oncolytic virus JX-594 could be demonstrated by MRI imaging in patients with advanced hepatocellular carcinoma (HCC), dynamic contrast-enhanced MRI of the liver was performed at baseline, day 5, and week 8 following intra-tumoral injection. Images were evaluated by a central reviewer blinded to treatment and dose using both modified RECIST and Choi response criteria. 17/30 subjects underwent day 5 (D5) post-treatment imaging; 28/30 had week 8 (W8) imaging. Results: Choi responses correlated more reliably than RECIST with JX-594 MOA. Evidence of intra-tumoral vascular shutdown, manifest by areas of reduced or non-enhancement (Choi response), was observed in 6 of 17 subjects on D5 5 MRI scans. Day 5 Choi responses were a predictor of week 8 Choi responses in all but 1 subject. Of the 11/17 D5 Choi non-responders, 3 were Choi responders at 8 weeks. Increase in size at D5 of small lesions present at baseline (“unmasking”) is compatible with oncolytic flare due to intra-tumoral edema contributed to by cell lysis and immune infiltration. RECIST criteria tumor measurements did not identify MOA of JX-594, and resulted in the appearance of pseudoprogression at D5 in some subjects. Conclusions: Hyperacute MRI post-therapy can be used to detect activity of the JX-594, a novel oncolytic anti-cancer therapy. Day 5 Choi responses were a predictor of subsequent response at week 8. Clinical trial information: NCT00554372.

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Expression and prognostic value of VEGFR-2, PDGFR-β, and c-Met in advanced hepatocellular carcinoma

Journal of Experimental & Clinical Cancer Research ◽

10.1186/1756-9966-32-16 ◽

2013 ◽

Vol 32 (1) ◽

pp. 16 ◽

Cited By ~ 55

Author(s):

Jie Sheng Chu ◽

Fei Jiao Ge ◽

Bo Zhang ◽

Yan Wang ◽

Nicola Silvestris ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Prognostic Value ◽

Advanced Hepatocellular Carcinoma

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Higher Enhancement Intrahepatic Nodules on the Hepatobiliary Phase of Gd-EOB-DTPA-Enhanced MRI as a Poor Responsive Marker of Anti-PD-1/PD-L1 Monotherapy for Unresectable Hepatocellular Carcinoma

Liver Cancer ◽

10.1159/000518048 ◽

2021 ◽

pp. 1-14

Author(s):

Tomoko Aoki ◽

Naoshi Nishida ◽

Kazuomi Ueshima ◽

Masahiro Morita ◽

Hirokazu Chishina ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Checkpoint Inhibitors ◽

Objective Response ◽

Evaluation Criteria ◽

Progression Free Survival ◽

Imaging Biomarker ◽

Hepatobiliary Phase ◽

Enhanced Mri ◽

Phase Images ◽

Magnetic Resonance Imaging Mri

Introduction: Immune checkpoint inhibitors (ICIs) are promising agents for the treatment of hepatocellular carcinoma (HCC). However, the establishment of noninvasive measure that could predict the response to ICIs is challenging. This study aimed to evaluate tumor responses to ICIs using the hepatobiliary phase of gadolinium-ethoxybenzyl-diethylenetriamine (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI), which was shown to reflect Wnt/β-catenin activating mutation. Methods: A total of 68 intrahepatic HCC nodules from 18 patients with unresectable HCC and Child-Pugh class A liver function who received anti-programmed cell death 1 (PD-1)/programmed death-ligand 1 (PD-L1) monotherapy were enrolled in this study. All patients had viable intrahepatic lesions evaluable using the hepatobiliary phase of Gd-EOB-DTPA-enhanced MRI within the 6 months prior to the treatment. The relative enhancement ratio was calculated, and the time to nodular progression (TTnP) defined as 20% or more increase in each nodule was compared between higher or hypo-enhancement HCC nodules. Then, the progression-free survival (PFS) and objective response rate (ORR) per Response Evaluation Criteria in Solid Tumors version 1.1 (RECIST v1.1) were compared between patients with and without HCC nodules with higher enhancement on hepatobiliary phase images. Results: The median PFS was 2.7 (95% confidence interval [CI]: 1.4–4.0) months in patients with HCC nodules with higher enhancement (n = 8) and 5.8 (95% CI: 0.0–18.9) months in patients with hypointense HCC nodules (n = 10) (p = 0.007). The median TTnP of HCC nodules with higher enhancement (n = 23) was 1.97 (95% CI: 1.86–2.07) months and that of hypointense HCC nodules (n = 45) was not reached (p = 0.003). The ORR was 12.5% (1/8) versus 30.0% (3/10); the disease control rate was 37.5% (3/8) versus 70.0% (7/10), respectively, in patients with or without higher enhancement intrahepatic HCC nodules. Conclusion: The TTnP on HCC nodules with higher enhancement and the median PFS in patients who carried higher enhancement intrahepatic HCC nodules were significantly shorter than those in hypointense HCC nodules with anti-PD-1/PD-L1 monotherapy. The intensity of the nodule on the hepatobiliary phase of Gd-EOB-DTPA-enhanced MRI is a promising imaging biomarker for predicting unfavorable response with anti-PD-1/PD-L1 monotherapy in patients with HCC.

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Importance of Microvascular Invasion Risk and Tumor Size on Recurrence and Survival of Hepatocellular Carcinoma After Anatomical Resection and Non-anatomical Resection

Frontiers in Oncology ◽

10.3389/fonc.2021.621622 ◽

2021 ◽

Vol 11 ◽

Author(s):

Haoyu Hu ◽

Shuo Qi ◽

Silue Zeng ◽

Peng Zhang ◽

Linyun He ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

High Risk ◽

Predictive Model ◽

Tumor Size ◽

Microvascular Invasion ◽

Low Risk ◽

Hepatobiliary Phase ◽

Imaging Features ◽

Anatomical Resection ◽

Anatomic Resection

Purpose: To establish a valid prediction model to prognose the occurrence of microvascular invasion (MVI), and to compare the efficacy of anatomic resection (AR) or non-anatomic resection (NAR) for hepatocellular carcinoma (HCC).Methods: Two hundred twenty-eight patients with HCC who underwent surgical treatment were enrolled. Their hematological indicators, MRI imaging features, and outcome data were acquired.Result: In the multivariable analysis, alpha-fetoprotein >15 ng/mL, neutrophil to lymphocyte ratio >3.8, corona enhancement, and peritumoral hypointensity on hepatobiliary phase were associated with MVI. According on these factors, the AUROC of the predictive model in the primary and validation cohorts was 0.884 (95% CI: 0.829, 0.938) and 0.899 (95% CI: 0.821, 0.967), respectively. Patients with high risk of MVI or those with low risk of MVI but tumor size >5 cm in the AR group were associated with a lower rate of recurrence and death than patients in the NAR group; however, when patients are in the state of low-risk MVI with tumor size >5 cm, there is no difference in the rate of recurrence and death between AR and NAR.Conclusion: Our predictive model for HCC with MVI is convenient and accurate. Patients with high-risk of MVI or low-risk of MVI but tumor size >5 cm executing AR is of great necessity.

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Prognostic value of the neutrophil-to-lymphocyte ratio in the ARQ 197-215 second-line study for advanced hepatocellular carcinoma

Oncotarget ◽

10.18632/oncotarget.14797 ◽

2017 ◽

Vol 8 (9) ◽

pp. 14408-14415 ◽

Cited By ~ 14

Author(s):

Nicola Personeni ◽

Laura Giordano ◽

Giovanni Abbadessa ◽

Camillo Porta ◽

Ivan Borbath ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Prognostic Value ◽

Neutrophil To Lymphocyte Ratio ◽

Advanced Hepatocellular Carcinoma ◽

Second Line ◽

Lymphocyte Ratio ◽

Arq 197

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Response Assessment Following Image-Guided Therapy of Hepatocellular Carcinoma

Journal of Clinical Interventional Radiology ISVIR ◽

10.1055/s-0040-1708579 ◽

2020 ◽

Vol 4 (02) ◽

pp. 088-097 ◽

Cited By ~ 1

Author(s):

Pankaj Gupta ◽

Naveen Kalra ◽

Ajay Gulati ◽

Vishnu Dev ◽

Ujjwal Gorsi ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Residual Disease ◽

Evaluation Criteria ◽

Response Assessment ◽

Imaging Biomarkers ◽

Imaging Features ◽

Image Guided Therapy ◽

Image Guided ◽

Guided Therapy

AbstractImage-guided locoregional therapies have an important role in the management of patients with hepatocellular carcinoma (HCC). Recent advances in the ablative as well as endovascular therapies have expanded the role of interventional radiologists in the treatment of HCC. Following image-guided therapy, an accurate response assessment is vital. Knowledge regarding normal postprocedure changes and subtle signs of residual or recurrent disease is important. In this review, we discuss various response evaluation criteria currently employed for HCC. We also discuss the postprocedure imaging features suggestive of residual disease or recurrence and imaging biomarkers for response assessment.

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