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Response stratification and survival analysis of hepatocellular carcinoma patients treated with intra‐arterial therapy using MR imaging‐based arterial enhancement fraction
Author(s) -
Bonekamp Susanne,
Bonekamp David,
Geschwind JeanFrancois H.,
CoronaVillalobos Celia Pamela,
Reyes Diane K.,
Pawlik Timothy M.,
Kamel Ihab R.
Publication year - 2014
Publication title -
journal of magnetic resonance imaging
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.563
H-Index - 160
eISSN - 1522-2586
pISSN - 1053-1807
DOI - 10.1002/jmri.24465
Subject(s) - hepatocellular carcinoma , medicine , response evaluation criteria in solid tumors , proportional hazards model , hazard ratio , liver cancer , nuclear medicine , radiology , target lesion , gastroenterology , confidence interval , progressive disease , chemotherapy , percutaneous coronary intervention , myocardial infarction
Purpose To investigate the feasibility that arterial enhancement fraction (AEF) is associated with response of hepatocellular carcinoma (HCC) following intra‐arterial therapy (IAT) and to compare AEF response with currently used tumor response metrics. Materials and Methods The AEF, Response Evaluation Criteria in Solid Tumors (RECIST), modified RECIST (mRECIST), and European Association for the Study of the Liver (EASL) of the largest treated index lesion and AEF of the tumor‐free hepatic parenchyma was measured on representative axial images in 131 patients (108 male; mean age, 61.9 years). Clinical measures and patient survival were assessed. Statistical analysis included Wilcoxon signed‐rank test and the COX proportional hazards model. Results After IAT, the mean AEF of the tumor decreased by 22% (66.7–44.8%, P < 0.0001), while the mean AEF of the tumor‐free parenchyma remained unchanged (27.2–26.5%, P = 0.50). Median survival of all 131 patients with liver cancer was 17 months. Patients were stratified into AEF‐responders if they had an AEF‐decrease ≥35% (AEF‐responders: n = 67; AEF‐nonresponders: n = 64). AEF‐responders survived longer than nonresponders (34.8 months versus 10.8 months, hazard ratio = 0.39; P < 0.0001). Responders according to RECIST, mRECIST, or EASL did not survive significantly longer compared with nonresponders. Conclusion Evaluating the AEF values based on tri‐phasic MRI is associated with tumor response in patients with unresectable HCC treated with IAT. J. Magn. Reson. Imaging 2014;40:1103–1111 . © 2013 Wiley Periodicals, Inc .