Tumor response assessment in hepatocellular carcinoma treated with immunotherapy: imaging biomarkers for clinical decision-making

期刊论文
发表日期：

2024年7月20日

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Rabea Sobirey,
Nickolai Matuschewski,
Moritz Gross,
MingDe Lin,
Tabea Kao,
Victor Kasolowsky,
Mario Strazzabosco,
Stacey Stein,
Lynn Jeanette Savic,
Bernhard Gebauer,
Ariel Jaffe,
James Duncan,
David C. Madoff,
Julius Chapiro

摘要

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.