Pretreatment Heterogeneous Enhancement Pattern of Hepatocellular Carcinoma May Be a Useful New Predictor of Early Response to Lenvatinib and Overall Prognosis
Pretreatment Heterogeneous Enhancement Pattern of Hepatocellular Carcinoma May Be a Useful New Predictor of Early Response to Lenvatinib and Overall Prognosis
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DOI：
10.1159/000505190
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发表时间：
2020-06-01
期刊：
影响因子：
13.8
通讯作者：
Kumada, Hiromitsu
中科院分区：
文献类型：
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作者：
Kawamura, Yusuke;Kobayashi, Masahiro;Kumada, Hiromitsu
目的：本研究的目的是评估肝细胞癌(肝细胞癌)的CT增强扫描作为潜在的预测伦瓦替尼疗效的指标及其与生存结果的相关性。方法：我们评估了51例不能切除的肝细胞癌患者。在影像分析中，动脉/门脉期动态CT图像分为：2型，均匀强化伴动脉血流增加，3型，不均匀强化，间隔样结构，4型，不均匀强化，环形结构不规则。结果：51例患者中，38例(75%)有客观反应(OR)。ORS在异质性强化的肝癌(3型和4型)中明显多于同质性肝癌(2型)(分别为83%和53%；p=0.037)。多变量分析显示，治疗前的不均匀强化模式是对Lenvatinib疗效的独立预测因素(优势比为4.75；p=0.042)。OR的存在与较长的无进展生存期(PFS)相关(Risk Ratio，0.36；p=0.017)，肿瘤侵袭性为3型和4型的患者无进展生存期(PFS)与2型肿瘤相似(p=0.455)，反映OR在3型或4型肿瘤中比2型肿瘤更常见。尽管4型肿瘤患者的进展后存活率极低(p=0.064)，但三组患者引入lenvatinib后的总体存活率无统计学差异(p=0.053)。结论：肝细胞癌的CT增强模式可预测对lenvatinib的疗效。或似乎更多地发生在具有肿瘤侵袭性特征的肝细胞癌中，并可能通过延长无进展间期而延长生存时间，即使在肿瘤风险较低的患者组中也是如此。
Objective:The aim of this study was to evaluate the performance of pretreatment computed tomography (CT) enhancement of hepatocellular carcinoma (HCC) as a potential predictor of response to lenvatinib and its relevance to survival outcomes.Methods:We evaluated 51 consecutive patients who received lenvatinib treatment for unresectable HCC. On imaging analysis, pretreatment arterial/portal phase dynamic CT images were classified as follows: type 2, homogeneous enhancement pattern with increased arterial blood flow; type 3, heterogeneous enhancement pattern with a septum-like structure; and type 4, heterogeneous enhancement pattern with irregularly shaped ring structures. Treatment response was evaluated using modified Response Evaluation Criteria in Solid Tumors at 2-12 weeks after initiation of lenvatinib, and the correlations between the CT enhancement patterns and response to lenvatinib or survival outcomes were investigated.Results:Of the 51 patients, 38 (75%) experienced an objective response (OR). ORs were significantly more common in heterogeneously enhanced HCC (types 3 and 4) than in homogeneous HCC (type 2) (83 vs. 53%, respectively;p= 0.037). Multivariate analysis revealed that pretreatment heterogeneous enhancement pattern is an independent predictor for response to lenvatinib (odds ratio, 4.75;p= 0.042). Presence of OR was associated with longer progression-free survival (PFS) (hazard ratio, 0.36;p= 0.017), and patients with oncologically aggressive type 3 and 4 tumors showed similar PFS to those harboring type 2 tumors (p= 0.455), reflecting that OR was more common in type 3 or 4 tumors compared with type 2 tumors. Although postprogression survival was extremely poor in patients with type 4 tumors (p= 0.064), overall survival after introduction of lenvatinib was not statistically different among the three groups of patients (p= 0.053).Conclusion:The CT enhancement pattern of HCC may predict response to lenvatinib. OR seems to occur more frequently in HCC with oncologically aggressive features and may contribute to prolonged survival through a prolonged progression-free interval, even in an oncologically poor-risk group of patients.