Prognostic value of baseline imaging and clinical features in patients with advanced hepatocellular carcinoma
Osman Öcal 1 , Michael Ingrisch 1 , Muzaffer Reha Ümütlü 1 , Bora Peynircioglu 2 , Christian Loewe 3 , Otto van Delden 4 , Vincent Vandecaveye 5 , Bernhard Gebauer 6 , Christoph J Zech 7 , Christian Sengel 8 , Irene Bargellini 9 , Roberto Iezzi 10 , Alberto Benito 11 , Maciej Pech 12 , Peter Malfertheiner 13 , Jens Ricke 1 , Max Seidensticker 14
Aims: To investigate the prognostic value of baseline imaging features for overall survival (OS) and liver decompensation (LD) in patients with hepatocellular carcinoma (HCC).
Design: Patients with advanced HCC from the SORAMIC trial were evaluated in this post hoc analysis. Several radiological imaging features were collected from baseline computed tomography (CT) and magnetic resonance imaging (MRI) imaging, besides clinical values.
The prognostic value of these features for OS and LD (grade 2 bilirubin increase) was quantified with univariate Cox proportional hazard models and multivariate Least Absolute Shrinkage and Selection Operator (LASSO) regression.
Results: Three hundred and seventy-six patients were included in this study. The treatment arm was not correlated with OS. LASSO showed satellite lesions, atypical HCC, peritumoral arterial enhancement, larger tumour size, higher albumin-bilirubin (ALBI) score, liver-spleen ratio <1.5, ascites, pleural effusion and higher bilirubin values were predictors of worse OS, and higher relative liver enhancement, smooth margin and capsule were associated with better OS.
LASSO analysis for LD showed satellite lesions, peritumoral hypointensity in hepatobiliary phase, high ALBI score, higher bilirubin values and ascites were predictors of LD, while randomisation to sorafenib arm was associated with lower LD.
Conclusions: Imaging features showing aggressive tumour biology and poor liver function, in addition to clinical parameters, can serve as imaging biomarkers for OS and LD in patients receiving sorafenib and selective internal radiation therapy for HCC.
CITATION Br J Cancer. 2022 Feb;126(2):211-218. doi: 10.1038/s41416-021-01577-6. Epub 2021 Oct 22.