Identifying staging markers for hepatocellular carcinoma before transarterial chemoembolization: Comparison of three-dimensional quantitative versus non-three-dimensional imaging markers

Julius Chapiro, Rafael Duran, Mingde Lin, Rüdiger E. Schernthaner, Zhijun Wang, Boris Gorodetski, Jean François Geschwind

Research output: Contribution to journalArticle

Abstract

Purpose: To test and compare the association between radiologic measurements of lesion diameter, volume, and enhancement on baseline magnetic resonance (MR) images with overall survival and tumor response in patients with unresectable hepatocellular carcinoma (HCC) treated with transarterial chemoembolization (TACE). Materials and Methods: This HIPAA-compliant retrospective, single-institution analysis was approved by the institutional review board, with waiver of informed consent. It included 79 patients with unresectable HCC who were treated with TACE. Baseline arterial phase contrast material-enhanced (CE) MR imaging was used to measure the overall and enhancing tumor diameters. A segmentation-based three-dimensional quantification of the overall and enhancing tumor volumes was performed in each patient. Numeric cutoff values (5 cm for diameters and 65 cm3 for volumes) were used to stratify the patient cohort in two groups. Tumor response rates according to Response Evaluation Criteria in Solid Tumors (RECIST), modified RECIST (mRECIST), and European Association for the Study of the Liver (EASL) guidelines were recorded for all groups. Survival was evaluated by using Kaplan- Meier analysis and was compared by using Cox proportional hazard ratios (HRs) after univariate and multivariate analysis. Results: Stratification according to overall and enhancing tumor diameters did not result in a significant separation of survival curves (HR, 1.4; 95% confidence interval [CI]: 0.7, 2.5; P = .234; and HR, 1.6; 95% CI: 0.9, 2.8; P = .08, respectively). The stratification according to overall and enhancing tumor volume achieved significance (HR, 1.8; 95% CI: 0.9, 3.4; P = .022; and HR, 1.8; 95% CI: 1.1, 3.1; P = .017, respectively). As for tumor response, higher response rates were observed in smaller lesions compared with larger lesions, when the 5-cm threshold (27% vs 15% for mRECIST and 45% vs 24% for EASL) was used. Conclusion: As opposed to anatomic tumor diameter as the most commonly used staging marker, volumetric assessment of lesion size and enhancement on baseline CE MR images is strongly associated with survival of patients with HCC who were treated with TACE.

Original languageEnglish (US)
Pages (from-to)438-447
Number of pages10
JournalRadiology
Volume275
Issue number2
DOIs
StatePublished - May 1 2015

Fingerprint

Hepatocellular Carcinoma
Confidence Intervals
Neoplasms
Survival
Tumor Burden
Contrast Media
Magnetic Resonance Spectroscopy
Health Insurance Portability and Accountability Act
Research Ethics Committees
Kaplan-Meier Estimate
Informed Consent
Multivariate Analysis
Magnetic Resonance Imaging
Guidelines
Liver
Response Evaluation Criteria in Solid Tumors

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

Identifying staging markers for hepatocellular carcinoma before transarterial chemoembolization : Comparison of three-dimensional quantitative versus non-three-dimensional imaging markers. / Chapiro, Julius; Duran, Rafael; Lin, Mingde; Schernthaner, Rüdiger E.; Wang, Zhijun; Gorodetski, Boris; Geschwind, Jean François.

In: Radiology, Vol. 275, No. 2, 01.05.2015, p. 438-447.

Research output: Contribution to journalArticle

Chapiro, Julius ; Duran, Rafael ; Lin, Mingde ; Schernthaner, Rüdiger E. ; Wang, Zhijun ; Gorodetski, Boris ; Geschwind, Jean François. / Identifying staging markers for hepatocellular carcinoma before transarterial chemoembolization : Comparison of three-dimensional quantitative versus non-three-dimensional imaging markers. In: Radiology. 2015 ; Vol. 275, No. 2. pp. 438-447.
@article{11bf25145df0408f895102bad0372d7b,
title = "Identifying staging markers for hepatocellular carcinoma before transarterial chemoembolization: Comparison of three-dimensional quantitative versus non-three-dimensional imaging markers",
abstract = "Purpose: To test and compare the association between radiologic measurements of lesion diameter, volume, and enhancement on baseline magnetic resonance (MR) images with overall survival and tumor response in patients with unresectable hepatocellular carcinoma (HCC) treated with transarterial chemoembolization (TACE). Materials and Methods: This HIPAA-compliant retrospective, single-institution analysis was approved by the institutional review board, with waiver of informed consent. It included 79 patients with unresectable HCC who were treated with TACE. Baseline arterial phase contrast material-enhanced (CE) MR imaging was used to measure the overall and enhancing tumor diameters. A segmentation-based three-dimensional quantification of the overall and enhancing tumor volumes was performed in each patient. Numeric cutoff values (5 cm for diameters and 65 cm3 for volumes) were used to stratify the patient cohort in two groups. Tumor response rates according to Response Evaluation Criteria in Solid Tumors (RECIST), modified RECIST (mRECIST), and European Association for the Study of the Liver (EASL) guidelines were recorded for all groups. Survival was evaluated by using Kaplan- Meier analysis and was compared by using Cox proportional hazard ratios (HRs) after univariate and multivariate analysis. Results: Stratification according to overall and enhancing tumor diameters did not result in a significant separation of survival curves (HR, 1.4; 95{\%} confidence interval [CI]: 0.7, 2.5; P = .234; and HR, 1.6; 95{\%} CI: 0.9, 2.8; P = .08, respectively). The stratification according to overall and enhancing tumor volume achieved significance (HR, 1.8; 95{\%} CI: 0.9, 3.4; P = .022; and HR, 1.8; 95{\%} CI: 1.1, 3.1; P = .017, respectively). As for tumor response, higher response rates were observed in smaller lesions compared with larger lesions, when the 5-cm threshold (27{\%} vs 15{\%} for mRECIST and 45{\%} vs 24{\%} for EASL) was used. Conclusion: As opposed to anatomic tumor diameter as the most commonly used staging marker, volumetric assessment of lesion size and enhancement on baseline CE MR images is strongly associated with survival of patients with HCC who were treated with TACE.",
author = "Julius Chapiro and Rafael Duran and Mingde Lin and Schernthaner, {R{\"u}diger E.} and Zhijun Wang and Boris Gorodetski and Geschwind, {Jean Fran{\cc}ois}",
year = "2015",
month = "5",
day = "1",
doi = "10.1148/radiol.14141180",
language = "English (US)",
volume = "275",
pages = "438--447",
journal = "Radiology",
issn = "0033-8419",
publisher = "Radiological Society of North America Inc.",
number = "2",

}

TY - JOUR

T1 - Identifying staging markers for hepatocellular carcinoma before transarterial chemoembolization

T2 - Comparison of three-dimensional quantitative versus non-three-dimensional imaging markers

AU - Chapiro, Julius

AU - Duran, Rafael

AU - Lin, Mingde

AU - Schernthaner, Rüdiger E.

AU - Wang, Zhijun

AU - Gorodetski, Boris

AU - Geschwind, Jean François

PY - 2015/5/1

Y1 - 2015/5/1

N2 - Purpose: To test and compare the association between radiologic measurements of lesion diameter, volume, and enhancement on baseline magnetic resonance (MR) images with overall survival and tumor response in patients with unresectable hepatocellular carcinoma (HCC) treated with transarterial chemoembolization (TACE). Materials and Methods: This HIPAA-compliant retrospective, single-institution analysis was approved by the institutional review board, with waiver of informed consent. It included 79 patients with unresectable HCC who were treated with TACE. Baseline arterial phase contrast material-enhanced (CE) MR imaging was used to measure the overall and enhancing tumor diameters. A segmentation-based three-dimensional quantification of the overall and enhancing tumor volumes was performed in each patient. Numeric cutoff values (5 cm for diameters and 65 cm3 for volumes) were used to stratify the patient cohort in two groups. Tumor response rates according to Response Evaluation Criteria in Solid Tumors (RECIST), modified RECIST (mRECIST), and European Association for the Study of the Liver (EASL) guidelines were recorded for all groups. Survival was evaluated by using Kaplan- Meier analysis and was compared by using Cox proportional hazard ratios (HRs) after univariate and multivariate analysis. Results: Stratification according to overall and enhancing tumor diameters did not result in a significant separation of survival curves (HR, 1.4; 95% confidence interval [CI]: 0.7, 2.5; P = .234; and HR, 1.6; 95% CI: 0.9, 2.8; P = .08, respectively). The stratification according to overall and enhancing tumor volume achieved significance (HR, 1.8; 95% CI: 0.9, 3.4; P = .022; and HR, 1.8; 95% CI: 1.1, 3.1; P = .017, respectively). As for tumor response, higher response rates were observed in smaller lesions compared with larger lesions, when the 5-cm threshold (27% vs 15% for mRECIST and 45% vs 24% for EASL) was used. Conclusion: As opposed to anatomic tumor diameter as the most commonly used staging marker, volumetric assessment of lesion size and enhancement on baseline CE MR images is strongly associated with survival of patients with HCC who were treated with TACE.

AB - Purpose: To test and compare the association between radiologic measurements of lesion diameter, volume, and enhancement on baseline magnetic resonance (MR) images with overall survival and tumor response in patients with unresectable hepatocellular carcinoma (HCC) treated with transarterial chemoembolization (TACE). Materials and Methods: This HIPAA-compliant retrospective, single-institution analysis was approved by the institutional review board, with waiver of informed consent. It included 79 patients with unresectable HCC who were treated with TACE. Baseline arterial phase contrast material-enhanced (CE) MR imaging was used to measure the overall and enhancing tumor diameters. A segmentation-based three-dimensional quantification of the overall and enhancing tumor volumes was performed in each patient. Numeric cutoff values (5 cm for diameters and 65 cm3 for volumes) were used to stratify the patient cohort in two groups. Tumor response rates according to Response Evaluation Criteria in Solid Tumors (RECIST), modified RECIST (mRECIST), and European Association for the Study of the Liver (EASL) guidelines were recorded for all groups. Survival was evaluated by using Kaplan- Meier analysis and was compared by using Cox proportional hazard ratios (HRs) after univariate and multivariate analysis. Results: Stratification according to overall and enhancing tumor diameters did not result in a significant separation of survival curves (HR, 1.4; 95% confidence interval [CI]: 0.7, 2.5; P = .234; and HR, 1.6; 95% CI: 0.9, 2.8; P = .08, respectively). The stratification according to overall and enhancing tumor volume achieved significance (HR, 1.8; 95% CI: 0.9, 3.4; P = .022; and HR, 1.8; 95% CI: 1.1, 3.1; P = .017, respectively). As for tumor response, higher response rates were observed in smaller lesions compared with larger lesions, when the 5-cm threshold (27% vs 15% for mRECIST and 45% vs 24% for EASL) was used. Conclusion: As opposed to anatomic tumor diameter as the most commonly used staging marker, volumetric assessment of lesion size and enhancement on baseline CE MR images is strongly associated with survival of patients with HCC who were treated with TACE.

UR - http://www.scopus.com/inward/record.url?scp=84929001336&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84929001336&partnerID=8YFLogxK

U2 - 10.1148/radiol.14141180

DO - 10.1148/radiol.14141180

M3 - Article

C2 - 25531387

AN - SCOPUS:84929001336

VL - 275

SP - 438

EP - 447

JO - Radiology

JF - Radiology

SN - 0033-8419

IS - 2

ER -