Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06510, USA.
Institute of Radiology, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität and Berlin Institute of Health, 10117, Berlin, Germany.
Eur Radiol. 2021 May;31(5):2737-2746. doi: 10.1007/s00330-020-07381-9. Epub 2020 Oct 30.
To compare 1D and 3D quantitative tumor response criteria applied to DCE-MRI in patients with advanced-stage HCC undergoing sorafenib therapy to predict overall survival (OS) early during treatment.
This retrospective analysis included 29 patients with advanced-stage HCC who received sorafenib for at least 60 days. All patients underwent baseline and follow-up DCE-MRI at 81.5 ± 29.3 days (range 35-140 days). Response to sorafenib was assessed in 46 target lesions using 1D criteria RECIST1.1 and mRECIST. In addition, a segmentation-based 3D quantification of absolute enhancing lesion volume (vqEASL) was performed on the arterial phase MRI, and the enhancement fraction of total tumor volume (%qEASL) was calculated. Accordingly, patients were stratified into groups of disease control (DC) and disease progression (DP). OS was evaluated using Kaplan-Meier curves with log-rank test and Cox proportional hazards regression model.
The Kaplan-Meier analysis revealed that stratification of patients in DC vs. DP according to mRECIST (p = 0.0371) and vqEASL (p = 0.0118) successfully captured response and stratified OS, while stratification according to RECIST and %qEASL did not correlate with OS (p = 0.6273 and p = 0.7474, respectively). Multivariable Cox regression identified tumor progression according to mRECIST and qEASL as independent risk factors of decreased OS (p = 0.039 and p = 0.006, respectively).
The study identified enhancement-based vqEASL and mRECIST as reliable predictors of patient survival early after initiation of treatment with sorafenib. This data provides evidence for potential advantages 3D quantitative, enhancement-based tumor response analysis over conventional techniques regarding early identification of treatment success or failure.
• Tumor response criteria on MRI can be used to predict survival benefit of sorafenib therapy in patients with advanced HCC. • Stratification into DC and DP using mRECIST and vqEASL significantly correlates with OS (p = 0.0371 and p = 0.0118, respectively) early after initiation of sorafenib, while stratification according to RECIST and %qEASL did not correlate with OS (p = 0.6273 and p = 0.7474, respectively). • mRECIST (HR = 0.325, p = 0.039. 95%CI 0.112-0.946) and qEASL (HR = 0.183, p = 0.006, 95%CI 0.055-0.613) are independent prognostic factors of survival in HCC patients undergoing sorafenib therapy.
比较应用于索拉非尼治疗的晚期 HCC 患者 DCE-MRI 的 1D 和 3D 定量肿瘤反应标准，以在治疗早期预测总生存期（OS）。
本回顾性分析纳入了 29 名接受索拉非尼治疗至少 60 天的晚期 HCC 患者。所有患者均在基线和 81.5±29.3 天（范围 35-140 天）进行了后续 DCE-MRI 检查。使用 1D 标准 RECIST1.1 和 mRECIST 对 46 个靶病变的索拉非尼反应进行评估。此外，还对动脉期 MRI 进行基于分割的绝对增强病变体积（vqEASL）定量，并计算总肿瘤体积的增强分数（%qEASL）。因此，根据疾病控制（DC）和疾病进展（DP）将患者分层。使用 Kaplan-Meier 曲线和对数秩检验以及 Cox 比例风险回归模型评估 OS。
Kaplan-Meier 分析表明，根据 mRECIST（p=0.0371）和 vqEASL（p=0.0118）将患者分层为 DC 与 DP 成功捕获了反应并分层了 OS，而根据 RECIST 和 %qEASL 分层与 OS 不相关（p=0.6273 和 p=0.7474）。多变量 Cox 回归确定 mRECIST 和 qEASL 下的肿瘤进展是 OS 降低的独立危险因素（p=0.039 和 p=0.006）。
该研究确定了基于增强的 vqEASL 和 mRECIST 是索拉非尼治疗开始后患者生存的可靠预测因子。该数据为 3D 定量、基于增强的肿瘤反应分析在早期识别治疗成功或失败方面优于传统技术提供了证据。
• MRI 上的肿瘤反应标准可用于预测晚期 HCC 患者接受索拉非尼治疗的生存获益。• 在索拉非尼开始后早期，根据 mRECIST 和 vqEASL 进行的 DC 和 DP 分层与 OS 显著相关（p=0.0371 和 p=0.0118），而根据 RECIST 和 %qEASL 分层与 OS 不相关（p=0.6273 和 p=0.7474）。• mRECIST（HR=0.325，p=0.039，95%CI 0.112-0.946）和 qEASL（HR=0.183，p=0.006，95%CI 0.055-0.613）是索拉非尼治疗 HCC 患者生存的独立预后因素。
