Sobirey Rabea, Matuschewski Nickolai, Gross Moritz, Lin MingDe, Kao Tabea, Kasolowsky Victor, Strazzabosco Mario, Stein Stacey, Savic Lynn Jeanette, Gebauer Bernhard, Jaffe Ariel, Duncan James, Madoff David C, Chapiro Julius
Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA.
Department of Radiology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität, Berlin, Germany.
Eur Radiol. 2025 Jan;35(1):73-83. doi: 10.1007/s00330-024-10955-6. Epub 2024 Jul 20.
OBJECTIVE: To compare the performance of 1D and 3D tumor response assessment for predicting median overall survival (mOS) in patients who underwent immunotherapy for hepatocellular carcinoma (HCC). METHODS: Patients with HCC who underwent immunotherapy between 2017 and 2023 and received multi-phasic contrast-enhanced MRIs pre- and post-treatment were included in this retrospective study. Tumor response was measured using 1D, RECIST 1.1, and mRECIST, and 3D, volumetric, and percentage quantitative EASL (vqEASL and %qEASL). Patients were grouped into disease control vs progression and responders vs non-responders. Kaplan-Meier curves analyzed with log-rank tests assessed the predictive value for mOS. Cox regression modeling evaluated the association of clinical baseline parameters with mOS. RESULTS: This study included 37 patients (mean age, 69.1 years [SD, 8.0]; 33 men). The mOS was 16.9 months. 3D vqEASL and %qEASL successfully stratified patients into disease control and progression (vqEASL: HR 0.21, CI: 0.55-0.08, p < 0.001; %qEASL: HR 0.18, CI: 0.83-0.04, p = 0.013), as well as responder and nonresponder (vqEASL: HR 0.25, CI: 0.08-0.74, p = 0.007; %qEASL: HR 0.17, CI: 0.04-0.72, p = 0.007) for predicting mOS. The 1D criteria, mRECIST stratified into disease control and progression only (HR 0.24, CI: 0.65-0.09, p = 0.002), and RECIST 1.1 showed no predictive value in either stratification. Multivariate Cox regression identified alpha-fetoprotein > 500 ng/mL as a predictor for poor mOS (p = 0.04). CONCLUSION: The 3D quantitative enhancement-based response assessment tool qEASL can predict overall survival in patients undergoing immunotherapy for HCC and could identify non-responders. CLINICAL RELEVANCE STATEMENT: Using 3D quantitative enhancement-based tumor response criteria (qEASL), radiologists' predictions of tumor response in patients undergoing immunotherapy for HCC can be further improved. KEY POINTS: MRI-based tumor response criteria predict immunotherapy survival benefits in HCC patients. 3D tumor response assessment methods surpass current evaluation criteria in predicting overall survival during HCC immunotherapy. Enhancement-based 3D tumor response criteria are robust prognosticators of survival for HCC patients on immunotherapy.
目的：比较一维（1D）和三维（3D）肿瘤反应评估在预测接受免疫治疗的肝细胞癌（HCC）患者中位总生存期（mOS）方面的表现。 方法：本回顾性研究纳入了2017年至2023年间接受免疫治疗且治疗前后均接受多期对比增强MRI检查的HCC患者。使用1D、RECIST 1.1和mRECIST以及3D、体积和百分比定量欧洲肝脏研究学会标准（vqEASL和%qEASL）测量肿瘤反应。患者被分为疾病控制与进展组以及反应者与无反应者组。采用对数秩检验分析的Kaplan-Meier曲线评估了对mOS的预测价值。Cox回归模型评估了临床基线参数与mOS的关联。 结果：本研究纳入了37例患者（平均年龄69.1岁[标准差8.0]；33例男性）。mOS为16.9个月。3D vqEASL和%qEASL成功地将患者分为疾病控制组和进展组（vqEASL：风险比[HR]0.21，置信区间[CI]：0.55 - 0.08，p < 0.001；%qEASL：HR 0.18，CI：0.83 - 0.04，p = 0.013），以及反应者和无反应者组（vqEASL：HR 0.25，CI：0.08 - 0.74，p = 0.007；%qEASL：HR 0.17，CI：0.04 - 0.72，p = 0.007）以预测mOS。1D标准、mRECIST仅能将患者分为疾病控制组和进展组（HR 0.24，CI：0.65 - 0.09，p = 0.002），而RECIST 1.1在两种分层中均无预测价值。多变量Cox回归确定甲胎蛋白>500 ng/mL是mOS较差的预测因素（p = 0.04）。 结论：基于3D定量增强的反应评估工具qEASL可预测接受HCC免疫治疗患者的总生存期，并可识别无反应者。 临床相关性声明：使用基于3D定量增强的肿瘤反应标准（qEASL），放射科医生对接受HCC免疫治疗患者肿瘤反应的预测可进一步改善。 关键点：基于MRI的肿瘤反应标准可预测HCC患者免疫治疗的生存获益。3D肿瘤反应评估方法在预测HCC免疫治疗期间的总生存期方面优于当前评估标准。基于增强的3D肿瘤反应标准是接受免疫治疗的HCC患者生存的有力预后指标。
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