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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.

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