Prognostic value of early response in predicting survival in hepatocellular carcinoma patients treated with selective internal radiation therapy

Objectives

This study evaluates the prognostic value of tumor response on CT at 3 months, assessed by Response Evaluation Criteria in Solid Tumors (RECIST), modified RECIST (mRECIST), and Liver Imaging Reporting and Data System Treatment Response Algorithm (LR-TRA) in patients with hepatocellular carcinoma (HCC) treated with selective internal radiation therapy (SIRT).

Materials and methods

A retrospective analysis was conducted on 102 HCC patients treated with SIRT between 2018 and 2020. RECIST, mRECIST, and LR-TRA were assessed at 3 months post-SIRT. Overall survival (OS) and progression-free survival (PFS) were assessed using Kaplan–Meier analysis and Cox proportional-hazards models.

Results

The median age was 71 years, and most patients (90%) had advanced-stage tumors (Barcelona Clinic Liver Cancer-C). After a median follow-up of 32.0 months (95% CI: 16.8–60.9), 60/102 patients died (59%), and 90/102 patients showed tumor progression (88%). Median OS was 20.4 months (95% CI: 15.4–33.0), and median PFS was 14.5 months (95% CI: 6.5–24.5); 1-year OS and PFS rates were 65.6% and 50.7%. Multivariable analysis revealed that early response according to RECIST 1.1 (HR 1.66, p = 0.30), mRECIST (HR 1.40, p = 0.215), and LR-TRA (HR 0.67, p = 0.30) were not predictors of OS. Disease progression evaluated by RECIST (HR 2.55, p < 0.001) and mRECIST (HR 2.53, p < 0.001), bilirubin levels (HR 1.03, p < 0.001), and prothrombin time (HR 0.98, p = 0.005) were predictors of OS. For PFS, neither RECIST nor mRECIST response, disease progression, nor LR-TRA viability were predictors.

Conclusion

In this advanced-stage HCC population, early response assessed by RECIST, mRECIST, and LR-TRA criteria did not predict OS or PFS after SIRT. However, early disease progression and liver function indicators were prognostic factors for OS.

Key Points

QuestionHow well does early tumor response, assessed at 3 months post-selective internal radiation therapy (SIRT), predict survival in advanced hepatocellular carcinoma (HCC) patients?

Findings Early response, assessed by RECIST, mRECIST, and LR-TRA, did not predict overall or progression-free survival; disease progression and liver function indicators were significant predictors.

Clinical relevance This study highlights the limitations of early imaging criteria in predicting survival outcomes in advanced HCC post-SIRT, suggesting the need for alternative or complementary prognostic indicators to guide treatment decisions.