Abstract
Transcatheter arterial chemoembolization (TACE) and sorafenib combination treatment for unselected hepatocellular carcinoma (HCC) is controversial. We explored the potential of texture analysis for appropriate patient selection. There were 261 HCCs included (TACE group: n = 197; TACE plus sorafenib (TACE+Sorafenib) group n = 64). We applied a Gabor filter and wavelet transform with 3 band-width responses (filter 0, 1.0, and 1.5) to portal-phase computed tomography (CT) images of the TACE group. Twenty-one textural parameters per filter were extracted from the region of interests delineated around tumor outline. After testing survival correlations, the TACE group was subdivided according to parameter thresholds in receiver operating characteristic curves and compared to TACE+Sorafenib group survival. The Gabor-1-90 (filter 0) was most significantly correlated with TTP. The TACE group was accordingly divided into the TACE-1 (Gabor-1-90 ≤ 3.6190) and TACE-2 (Gabor-1-90 > 3.6190) subgroups; TTP was similar in the TACE-1 subgroup and TACE+Sorafenib group, but shorter in the TACE-2 subgroup. Only wavelet-3-D (filter 1.0) correlated with overall survival (OS), and was used for subgrouping. The TACE-5 (wavelet-3-D ≤ 12.2620) subgroup and the TACE+Sorafenib group showed similar OS, while the TACE-6 (wavelet-3-D > 12.2620) subgroup had shorter OS. Gabor-1-90 and wavelet-3-D were consistent. In dependent of tumor number or size, CT textural parameters are correlated with TTP and OS. Patients with lower Gabor-1-90 (filter 0) and wavelet-3-D (filter 1.0) should be treated with TACE and sorafenib. Texture analysis holds promise for appropriate selection of HCCs for this combination therapy.
Highlights
Hepatocellular carcinoma (HCC) has been proven to be a leading cause of cancer-related death worldwide [1,2,3]
The Transcatheter arterial chemoembolization (TACE) group was divided into the TACE-1 (Gabor-1-90 ≤ 3.6190) and TACE-2 (Gabor-1-90 > 3.6190) subgroups; time to progression (TTP) was similar in the TACE-1 subgroup and TACE+Sorafenib group, but shorter in the TACE-2 subgroup
In a previous study, we have proven that texture analysis was promising for hepatocellular carcinoma (HCC) patient stratification for determining the suitability of liver resection vs. TACE [29]
Summary
Hepatocellular carcinoma (HCC) has been proven to be a leading cause of cancer-related death worldwide [1,2,3]. The combination of sorafenib and TACE was anticipated to be a breakthrough, and some studies had proven the safety and potential efficacy of the combination [7, 12], 2 recent randomized control trails drew a contrary conclusion about this combination therapy [13, 14] These controversies indicated that not all patients obtain a survival benefit from the combination. Multiples studies have sought potential factors, including clinical factors [15], biomarkers [16], and radiological characteristics [17], that could predict the efficacy of TACE or sorafenib These studies provided meaningful insight in HCC prognosis, they fell short of accurate patients’ identification, for the combination of TACE and sorafenib
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