Department of Radiology, School of Medicine, Ajou University, Suwon, South Korea.
Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
Eur Radiol. 2021 Apr;31(4):2507-2517. doi: 10.1007/s00330-020-07357-9. Epub 2020 Oct 8.
We investigated whether liver stiffness (LS) quantified using magnetic resonance elastography (MRE) could predict the prognosis of advanced hepatocellular carcinoma (HCC) patients treated with sorafenib.
We selected 50 sorafenib-treated advanced HCC patients who underwent MRE within 3 months before drug administration from a prospectively maintained cohort of chronic liver disease patients, according to the inclusion and exclusion criteria. Univariate and multivariate analyses were performed to evaluate the prognostic role of laboratory data, tumor characteristics, and MRE-assessed LS for overall survival (OS), progression-free survival (PFS), and significant liver injury (grade ≥ 3) after sorafenib administration.
High MRE-assessed LS either as continuous (per kPa, hazard ratio (HR) 1.54; 95% confidence interval (CI) 1.23-1.92, p < 0.001) or categorical (> 7.5 kPa, HR 4.06, 95% CI 1.40-11.79, p < 0.01) variable was significantly associated with poor OS along with higher serum alpha-fetoprotein (AFP, ≥ 400 ng/mL) and advanced tumor stage (modified Union for International Cancer Control (mUICC) IVb). Higher MRE-assessed LS was also significantly associated with the development of significant liver injury after sorafenib administration (per kPa, HR 1.62, 95% CI 1.21-2.17, p = 0.001; > 7.5 kPa, HR 10.11, 95% CI 2.41-42.46, p = 0.002). PFS analysis identified higher serum AFP (≥ 400 ng/mL) and advanced tumor stage (mUICC IVb) as significant risk factors for early disease progression, whereas LS was not associated with PFS CONCLUSION: Higher MRE-assessed LS is a potential biomarker for predicting poor OS and significant liver injury in advanced HCC patients treated with sorafenib.
• Higher pretreatment LS by MRE (> 7.5 kPa), higher AFP (≥ 400 ng/mL), and advanced tumor stage (mUICC IVb) were associated with poor OS in advanced HCC patients treated with sorafenib. • Higher pretreatment LS by MRE was associated with developing significant (grade ≥ 3) liver injury during sorafenib treatment, which required termination of the therapy. • Patients with high pretreatment LS by MRE should be monitored carefully for potential liver injury during sorafenib treatment.
我们研究了磁共振弹性成像（MRE）定量检测的肝硬度（LS）是否可预测接受索拉非尼治疗的晚期肝细胞癌（HCC）患者的预后。
我们根据纳入和排除标准，从慢性肝病患者前瞻性队列中选择了 50 名在药物治疗前 3 个月内接受 MRE 检查的接受索拉非尼治疗的晚期 HCC 患者。采用单变量和多变量分析来评估实验室数据、肿瘤特征和 MRE 评估的 LS 对总生存期（OS）、无进展生存期（PFS）和索拉菲尼治疗后发生显著肝损伤（≥3 级）的预后作用。
较高的 MRE 评估 LS 无论是连续变量（每 kPa，风险比（HR）为 1.54；95%置信区间（CI）为 1.23-1.92，p < 0.001）还是分类变量（>7.5 kPa，HR 为 4.06，95%CI 为 1.40-11.79，p < 0.01），均与较差的 OS 显著相关，同时伴有较高的血清甲胎蛋白（AFP，≥400 ng/mL）和晚期肿瘤分期（改良国际抗癌联盟（mUICC）IVb）。较高的 MRE 评估 LS 也与索拉非尼治疗后发生显著肝损伤显著相关（每 kPa，HR 为 1.62，95%CI 为 1.21-2.17，p = 0.001；>7.5 kPa，HR 为 10.11，95%CI 为 2.41-42.46，p = 0.002）。PFS 分析确定较高的血清 AFP（≥400 ng/mL）和晚期肿瘤分期（mUICC IVb）是疾病早期进展的显著危险因素，而 LS 与 PFS 无关。
较高的 MRE 评估 LS 是预测接受索拉非尼治疗的晚期 HCC 患者 OS 不良和显著肝损伤的潜在生物标志物。
• MRE 评估的较高 LS（>7.5 kPa）、较高 AFP（≥400 ng/mL）和晚期肿瘤分期（mUICC IVb）与接受索拉非尼治疗的晚期 HCC 患者的 OS 不良相关。
• MRE 评估的较高 LS 与索拉非尼治疗期间发生显著（≥3 级）肝损伤相关，需要终止治疗。
• 接受 MRE 评估的 LS 较高的患者在接受索拉非尼治疗期间应密切监测潜在的肝损伤。
