Feng Yiming, Zhang Hui, Ren Qianqian, Li Changde, Liu Song, Zheng Chuansheng, Xia Xiangwen
Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China.
Department of Internal Medicine, Wuhan Hankou Hospital, 172 Zhaojiatiao Road, Wuhan City, Hubei Province 430011, China.
Eur J Radiol. 2023 May;162:110784. doi: 10.1016/j.ejrad.2023.110784. Epub 2023 Mar 17.
To evaluate whether relative Hounsfield unit attenuation index (rHUAI) on contrast-enhanced computed tomography (CECT) can predict tumor response in advanced hepatocellular carcinoma (HCC) patients who received sequential combined treatment of immune checkpoint inhibitor (ICI) and anti-angiogenesis therapy.
One hundred seventeen advanced HCC patients who underwent the sequential combined treatment in a tertiary hospital between March 2020 and December 2021 were allocated to prediction and validation cohorts (with a ratio of 2:1) based on the time of initial ICI treatment. rHUAI from the arterial to the portal-venous phase (rHU_ap) and from the portal-venous to the delayed phase (rHU_pd) was calculated. The optimal cut-off values (COVs) of rHU_ap and rHU_pd for predicting tumor response were identified using Youden's index. Univariate and multivariable analyses were performed to assess the relationship between the COVs and tumor response. The validity of COVs was verified in the validation cohort using the chi-square test and Cramer's V coefficient (V).
The optimal COVs of the two observers were 0.5316 and 0.3265 for rHU_ap, and -0.0208 and -0.0048 for rHU_pd, respectively. Multivariable analysis suggested that the COVs were independently associated with tumor response in the prediction cohort (rHU_ap, Odds ratio: 7.727 and 7.808, 95 % CI: 2.516-23.728 and 2.399-25.410, p value < 0.001 and 0.001; rHU_pd, Odds ratio: 0.034 and 0.011, 95 % CI: 0.002-0.600 and 0.001-0.209, p value of 0.021 and 0.003). In the validation cohort, the optimal COVs of rHU_ap had a moderate to a strong association with tumor response (V = 0.362-0.545, p < 0.05). The association between COVs of rHU_pd and tumor response was slight to strong (V = 0.24-0.545, p = 0.001 to 0.134).
rHUAI obtained from CECT has the potential as a non-invasive tool for predicting tumor response in advanced HCC patients who have received combined ICI and anti-angiogenesis treatment.
评估在接受免疫检查点抑制剂（ICI）和抗血管生成治疗联合序贯治疗的晚期肝细胞癌（HCC）患者中，对比增强计算机断层扫描（CECT）上的相对亨氏单位衰减指数（rHUAI）能否预测肿瘤反应。
2020年3月至2021年12月在一家三级医院接受序贯联合治疗的117例晚期HCC患者，根据初始ICI治疗时间分为预测队列和验证队列（比例为2:1）。计算从动脉期到门静脉期的rHUAI（rHU_ap）以及从门静脉期到延迟期的rHUAI（rHU_pd）。使用约登指数确定预测肿瘤反应的rHU_ap和rHU_pd的最佳临界值（COV）。进行单因素和多因素分析以评估COV与肿瘤反应之间的关系。在验证队列中使用卡方检验和克莱默V系数（V）验证COV的有效性。
两位观察者的rHU_ap最佳COV分别为0.5316和0.3265，rHU_pd最佳COV分别为-0.0208和-0.0048。多因素分析表明，在预测队列中，COV与肿瘤反应独立相关（rHU_ap，比值比：7.727和7.808，95%置信区间：2.516 - 23.728和2.399 - 25.410，p值<0.001和0.001；rHU_pd，比值比：0.034和0.011，95%置信区间：0.002 - 0.600和0.001 - 0.209，p值为0.021和0.003）。在验证队列中，rHU_ap的最佳COV与肿瘤反应呈中度至强关联（V = 0.362 - 0.545，p < 0.05）。rHU_pd的COV与肿瘤反应之间的关联为轻度至强关联（V = 0.24 - 0.545，p = 0.001至0.134）。
从CECT获得的rHUAI有可能作为一种非侵入性工具，用于预测接受ICI和抗血管生成联合治疗的晚期HCC患者的肿瘤反应。
