Objectives To develop a nomogram based on low-dose one-stop dual-energy and perfusion computed tomography (LD-DE&PCT) for predicting the efficacy of transcatheter arterial chemoembolization (TACE) combined with lenvatinib and immune checkpoint inhibitors (TACE-LEN-ICIs) in unresectable hepatocellular carcinoma (uHCC) patients. Materials and methods This prospective, multicenter study included uHCC patients who underwent LD-DE&PCT scanning. The relationships between quantitative LD-DE&PCT-derived parameters and the efficacy of TACE-LEN-ICIs were analyzed using logistic regression analysis. A nomogram incorporating the independent predictors was constructed, and its predictive performance was evaluated by the area under the receiver operating characteristic curve (AUROC). Results A total of 125 lesions from 71 uHCC patients were enrolled, with 71 lesions (56.8%) classified as the objective response (ObR) group and 54 lesions (43.2%) as the non-response (NR) group. Univariate analysis revealed significant differences in tumor size, corona enhancement, tumor location, iodine concentration in the arterial phase (IC-AP), normalized iodine concentration in the arterial phase (NIC-AP), effective atomic number in the arterial phase (Zeff-AP), slope of spectral HU curve in the arterial phase (λHU-AP), and permeability surface area product (PS) between ObR and NR groups. Among these, NIC-AP exhibited the highest predictive value (AUROC = 0.770; 95% confidence interval [CI]: 0.682‒0.858). Multivariate analysis identified tumor size, NIC-AP, and PS as independent predictors. The nomogram showed excellent performance (AUROC = 0.913; 95% CI: 0.858–0.968). The total radiation dose was 19.02 ± 5.39 mSv. Conclusion The LD-DE&PCT-based nomogram can accurately predict the response to TACE-LEN-ICIs in uHCC patients. Relevance statement Low-dose one-stop dual-energy and perfusion CT provides a noninvasive method to predict response to TACE combined with lenvatinib and immune checkpoint inhibitors in unresectable HCC. Key Points <UnorderedList Mark="Bullet"> <ItemContent> Predicting response to TACE-LEN-ICIs in uHCC helps treatment decision-making. </ItemContent> <ItemContent> NIC-AP and PS from LD-DE&PCT, and tumor size were independent predictive biomarkers. </ItemContent> <ItemContent> NIC-AP was the best parameter for predicting response to TACE-LEN-ICIs in uHCC. </ItemContent> </UnorderedList> Graphical Abstract

Dual-energy CT biomarkers for predicting the efficacy of TACE combined with lenvatinib and immune checkpoint inhibitors in unresectable HCC

期刊论文
出版模式：

开放获取
发表日期：

2026年1月19日

查看全文

Jingwen Zhang,
Kai Zhang,
Taoming Du,
Cheng Yan,
Yingxuan Wang,
Mingzi Gao,
Jing Han,
Mingxin Zhang,
Yujie Chen,
Liqin Zhao

摘要

Objectives

To develop a nomogram based on low-dose one-stop dual-energy and perfusion computed tomography (LD-DE&PCT) for predicting the efficacy of transcatheter arterial chemoembolization (TACE) combined with lenvatinib and immune checkpoint inhibitors (TACE-LEN-ICIs) in unresectable hepatocellular carcinoma (uHCC) patients.

Materials and methods

This prospective, multicenter study included uHCC patients who underwent LD-DE&PCT scanning. The relationships between quantitative LD-DE&PCT-derived parameters and the efficacy of TACE-LEN-ICIs were analyzed using logistic regression analysis. A nomogram incorporating the independent predictors was constructed, and its predictive performance was evaluated by the area under the receiver operating characteristic curve (AUROC).

Results

A total of 125 lesions from 71 uHCC patients were enrolled, with 71 lesions (56.8%) classified as the objective response (ObR) group and 54 lesions (43.2%) as the non-response (NR) group. Univariate analysis revealed significant differences in tumor size, corona enhancement, tumor location, iodine concentration in the arterial phase (IC-AP), normalized iodine concentration in the arterial phase (NIC-AP), effective atomic number in the arterial phase (Z_eff-AP), slope of spectral HU curve in the arterial phase (λ_HU-AP), and permeability surface area product (PS) between ObR and NR groups. Among these, NIC-AP exhibited the highest predictive value (AUROC = 0.770; 95% confidence interval [CI]: 0.682‒0.858). Multivariate analysis identified tumor size, NIC-AP, and PS as independent predictors. The nomogram showed excellent performance (AUROC = 0.913; 95% CI: 0.858–0.968). The total radiation dose was 19.02 ± 5.39 mSv.

Conclusion

The LD-DE&PCT-based nomogram can accurately predict the response to TACE-LEN-ICIs in uHCC patients.

Relevance statement

Low-dose one-stop dual-energy and perfusion CT provides a noninvasive method to predict response to TACE combined with lenvatinib and immune checkpoint inhibitors in unresectable HCC.

Key Points

Predicting response to TACE-LEN-ICIs in uHCC helps treatment decision-making.

NIC-AP and PS from LD-DE&PCT, and tumor size were independent predictive biomarkers.

NIC-AP was the best parameter for predicting response to TACE-LEN-ICIs in uHCC.

Graphical Abstract