Performance of initial LI-RADS 2018 treatment response in predicting survival of patients with hepatocellular carcinoma following TACE: a retrospective, single-center cohort study

Krzysztof Bartnik,Michał Sajdek,Jakub Giziński,Grzegorz Rosiak,Tadeusz Wróblewski,Joanna Podgórska,Paweł Nyckowski,Olgierd Rowiński,Krzysztof Zieniewicz,Krzysztof Korzeniowski

doi:10.1007/s00432-021-03603-9

Krzysztof Bartnik, Michał Sajdek + Show 8 more

Open Access

https://doi.org/10.1007/s00432-021-03603-9

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Abstract

PurposeTreatment response following transarterial chemoembolization (TACE) is frequently evaluated with Liver Imaging Reporting and Data System Treatment Response (LR-TR) algorithm, but its association with patients’ outcomes is not supported in the literature. The purpose of this study was to provide such data.MethodsA retrospective analysis of 99 TACE patients with stage A/B hepatocellular carcinoma according to Barcelona-Clinic Liver Cancer staging system was performed. Two radiologists assessed LR-TR, while a third radiologist re-assessed divergent results. Overall survival (OS) and time to disease progression (TTP) were the primary endpoints of the study, while the Cox proportional hazard model was used for outcome analyses.ResultsInterobserver agreement was substantial between the two readers with κ = 0.69 (95% CI 0.58–0.81). The median OS in viable, equivocal, and non-viable groups were 27, 27, and 73 months, respectively (p < 0.001). However, after adjustment for confounding factors, there was no significant association between initial viable response and OS (HR 0.98 [95% CI 0.37–2.63], p = 0.97), while equivocal response remained statistically significant (HR 3.52. [95% CI 1.27–9.71], p = 0.015). No significant association was noted when viable and equivocal groups were analyzed in aggregate (HR 1.03 [95% CI 0.4–2.4], p = 0.96). The median TTP did not differ between non-viable and viable groups (23 vs 18 months, respectively; p = 0.98). None of the analyzed predictors was associated with TTP.ConclusionInitial LR-TR response was not an independent predictor for OS nor TTP. The preliminary results suggest the necessity for more aggressive management of equivocal patients.

Highlights

Hepatocellular carcinoma (HCC) represents an emerging challenge for health care providers given its increasing incidence and high mortality (Dimitroulis et al 2017)
An initial LR-TR response was assessed as a potential predictor of survival in HCC patients treated with transarterial chemoembolization (TACE)
The results indicate that the worse outcomes observed in HCC patients who did not achieve a non-viable response after the initial treatment cycle are due to unfavorable baseline characteristics rather than the prognostic impact of the initial treatment response itself

Summary

Introduction

Hepatocellular carcinoma (HCC) represents an emerging challenge for health care providers given its increasing incidence and high mortality (Dimitroulis et al 2017). To correctly evaluate treatment response, experienced health care providers are needed, which almost always need to be supported by a series of imaging examinations and laboratory tests (Mehta 2020). Journal of Cancer Research and Clinical Oncology (2021) 147:3673–3683 investments have been made in the development of robust, more effective algorithms to evaluate response to locoregional therapies. This has led to the development of the HCC-specific treatment response algorithm (LR-TR), as an expansion of the Liver Imaging Reporting and Data System (LI-RADS), aimed at assessing response after HCC locoregional therapy (Chaudhry et al 2020a). There are many studies showing the high specificity and sensitivity of LI-RADS for HCC reporting (Rosiak et al 2018a; Furlan 2019)

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