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

Osman Öcal,Max Seidensticker,Christian Loewe,Roberto Iezzi,Vincent Vandecaveye,Christian Sengel,Bora Peynircioglu,Alberto Benito,Irene Bargellini,Bernhard Gebauer,Muzaffer Reha Ümütlü,Christoph J Zech,Peter Malfertheiner,Michael Ingrisch,Jens Ricke,Maciej Pech,Otto Van Delden

doi:10.1038/s41416-021-01577-6

Abstract

SummaryAimsTo investigate the prognostic value of baseline imaging features for overall survival (OS) and liver decompensation (LD) in patients with hepatocellular carcinoma (HCC).DesignPatients 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.ResultsThree 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.ConclusionsImaging 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.

Highlights

Hepatocellular carcinoma (HCC) comprises 75–85% of all liver cancers and is the fourth most common cause of cancer-related death in the world [1]
Sorafenib has been shown to improve the overall survival (OS) of HCC patients compared to placebo in two randomised trials, and since it has been the standard treatment for advanced HCC cases [3, 4]
Trials comparing selective internal radiation therapy (SIRT) with sorafenib in intermediate-advanced HCC cases failed to show a survival benefit, they demonstrated higher tolerability of SIRT and the ability of SIRT to serve as an effective alternative therapy in patients who are not able to receive sorafenib [5, 6]

Summary

Introduction

Hepatocellular carcinoma (HCC) comprises 75–85% of all liver cancers and is the fourth most common cause of cancer-related death in the world [1]. Sorafenib has been shown to improve the overall survival (OS) of HCC patients compared to placebo in two randomised trials, and since it has been the standard treatment for advanced HCC cases [3, 4]. Subgroup analysis has shown increased benefit for some patient groups, including younger age, non-cirrhotic liver or non-alcoholic aetiology [7]. These results are compatible with the previous studies showing significant heterogeneity in outcomes of patients treated with sorafenib or SIRT [8]

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Results