Abstract
This study aimed to identify the utility of diffusion-weighted magnetic resonance (MR) imaging with an apparent diffusion coefficient (ADC) map as a predictor of the response of hepatocellular carcinoma (HCC) to cisplatin-based hepatic arterial infusion chemotherapy (HAIC). We retrospectively evaluated 113 consecutive patients with Barcelona Clinical Liver Cancer (BCLC) stage B or C HCC, who underwent gadoxetic acid-enhanced and diffusion-weighted MR imaging. The appropriate cutoff for the pretreatment tumor-to-liver ADC ratio was determined to be 0.741. Of the 113 patients, 50 (44%) presented with a pretreatment tumor-to-liver ADC ratio < 0.741 (low group). Evaluation of the treatment response after 2-3 cycles of HAIC in these 50 patients revealed that 21 patients (42%) experienced an objective response to HAIC. On the other hand, only 11 of the 63 patients (17%) with a pretreatment tumor-to-liver ADC ratio ≥ 0.741 (high group) showed an objective response. Thus, the objective response rate was significantly higher in the low group than in the high group (P = 0.006). Multivariate logistic regression analysis using parameters including perfusion alteration, percentage of non-enhancing portions, and pretreatment tumor-to-liver ADC ratio revealed that a pretreatment tumor-to-liver ADC ratio < 0.741 (odds ratio 3.217; P = 0.014) was the sole predictor of an objective response to HAIC. Overall survival rates were significantly higher in patients with objective responses to HAIC than in those without objective responses (P = 0.001 by log-rank test). In conclusion, patients with BCLC stage C or C HCC with a pretreatment tumor-to-liver ADC ratio < 0.741 showed a favorable intrahepatic response to cisplatin-based HAIC. Therefore, diffusion-weighted MR imaging can play a critical role as a predictor of response to cisplatin-based HAIC in unresectable HCC.
Highlights
Hepatocellular carcinoma (HCC) is the fourth most common cause of malignancy-related death worldwide [1]
This study aimed to identify the utility of diffusion-weighted magnetic resonance (MR) imaging with an apparent diffusion coefficient (ADC) map as a predictor of the response of hepatocellular carcinoma (HCC) to cisplatin-based hepatic arterial infusion chemotherapy (HAIC)
Before HAIC, the mean tumor ADC of the high group was not significantly different from that of the low group, the mean pretreatment tumor-to-liver ADC ratio was significantly lower in the low group (P < 0.001) (Table 2)
Summary
Hepatocellular carcinoma (HCC) is the fourth most common cause of malignancy-related death worldwide [1]. Sorafenib and lenvatinib are usually administered in cases of advanced HCC with portal vein tumor thrombus (PVTT) or extrahepatic metastasis. These drugs only have modest treatment responses and may even have notable side effects [3, 4]. Barcelona Clinical Liver Cancer (BCLC) stage B or C HCC cases with high intrahepatic tumor burden can alternatively be treated through hepatic arterial infusion chemotherapy (HAIC), whereby the drug is administered directly through a port inserted into the liver. Recent studies demonstrated that significant reduction of the intrahepatic tumor by HAIC in HCC with PVTT and/or extrahepatic metastases led to better survival outcomes than no reduction of the intrahepatic tumor burden [2, 8]. In advanced HCC, it is crucial to identify patients who will potentially benefit from HAIC before start the treatment
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