Hasmik Koulakian1, Wassim Allaham1, Valérie Vilgrain2,3, Maxime Ronot4,5,6. 1. Department of Radiology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, Hauts-de-Seine, France. 2. University Paris Diderot, Sorbonne Paris Cité, Paris, France. 3. INSERM U1149, Centre de Recherche Biomédicale Bichat-Beaujon, CRB3, Paris, France. 4. Department of Radiology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, Hauts-de-Seine, France. maxime.ronot@aphp.fr. 5. University Paris Diderot, Sorbonne Paris Cité, Paris, France. maxime.ronot@aphp.fr. 6. INSERM U1149, Centre de Recherche Biomédicale Bichat-Beaujon, CRB3, Paris, France. maxime.ronot@aphp.fr.
Abstract
OBJECTIVES: To evaluate the value of CT attenuation to assess the response to sorafenib in infiltrative/endovascular non-measurable advanced hepatocellular carcinoma (HCC). METHODS: From 2007 to 2014, patients with infiltrative HCC ± tumor-in-vein (TIV) were retrospectively included. Attenuation of tumors and TIV were measured at baseline and follow-up on arterial and portal venous phase CT by two independent radiologists. Attenuation changes (overall and as per Choi criteria) and Child-Pugh score were correlated to overall survival. RESULTS: Forty patients were included (38 men, 95%). Attenuation of both the tumors and TIV was significantly lower in follow-up CT than on baseline CT (p = 0.002 (arterial), and p = 0.001 (portal) for tumor, and p = 0.004 (arterial) and p < 0.001 (porta) for TIV). Median attenuation of TIV was significantly lower than that of the tumor in follow-up images (p = 0.010). Median OS for the entire cohort was 4 ± 1 months (95% CI: 2.1-5.9), with estimated OS rates at 6, 12, and 24 months of 43%, 29 and 12%, respectively. Baseline and follow-up CT attenuation in tumors and TVI were not correlated with survival. Survival was not significantly increased in patients with Choi criteria >15% CT HU decrease in the tumor and/or TIV during follow-up. Only Child-Pugh A (HR 4.9 (95%CI 2.3-10.7), p < 0.001) was identified as an independent factor of improved survival on multivariate analysis. CONCLUSION: Despite significant changes under sorafenib, tumor attenuation of infiltrative/endovascular non-measurable HCC may be of limited value to assess survival in this subgroup of patients with very poor prognosis. KEY POINTS: • Attenuation of both tumors and tumor-in-vein decreases after sorafenib. • Attenuation decrease is more marked in the tumor-in-vein than in the tumor. • Attenuation decrease is not associated with longer overall survival.
OBJECTIVES: To evaluate the value of CT attenuation to assess the response to sorafenib in infiltrative/endovascular non-measurable advanced hepatocellular carcinoma (HCC). METHODS: From 2007 to 2014, patients with infiltrative HCC ± tumor-in-vein (TIV) were retrospectively included. Attenuation of tumors and TIV were measured at baseline and follow-up on arterial and portal venous phase CT by two independent radiologists. Attenuation changes (overall and as per Choi criteria) and Child-Pugh score were correlated to overall survival. RESULTS: Forty patients were included (38 men, 95%). Attenuation of both the tumors and TIV was significantly lower in follow-up CT than on baseline CT (p = 0.002 (arterial), and p = 0.001 (portal) for tumor, and p = 0.004 (arterial) and p < 0.001 (porta) for TIV). Median attenuation of TIV was significantly lower than that of the tumor in follow-up images (p = 0.010). Median OS for the entire cohort was 4 ± 1 months (95% CI: 2.1-5.9), with estimated OS rates at 6, 12, and 24 months of 43%, 29 and 12%, respectively. Baseline and follow-up CT attenuation in tumors and TVI were not correlated with survival. Survival was not significantly increased in patients with Choi criteria >15% CT HU decrease in the tumor and/or TIV during follow-up. Only Child-Pugh A (HR 4.9 (95%CI 2.3-10.7), p < 0.001) was identified as an independent factor of improved survival on multivariate analysis. CONCLUSION: Despite significant changes under sorafenib, tumor attenuation of infiltrative/endovascular non-measurable HCC may be of limited value to assess survival in this subgroup of patients with very poor prognosis. KEY POINTS: • Attenuation of both tumors and tumor-in-vein decreases after sorafenib. • Attenuation decrease is more marked in the tumor-in-vein than in the tumor. • Attenuation decrease is not associated with longer overall survival.
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