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Imaging Predictors of Survival in Patients with Single Small Hepatocellular Carcinoma Treated with Transarterial Chemoembolization

Korean Journal of Radiology 2021년 22권 2호 p.213 ~ 224
박찬, 김진형, 김평화, 김소연, 권동일, Chu Hee-Ho, 박민호, 허준호, 김진영, 김동준,
소속 상세정보
박찬 ( Park Chan ) - University of Ulsan College of Medicine Asan Medical Center Department of Radiology
김진형 ( Kim Jin-Hyoung ) - University of Ulsan College of Medicine Asan Medical Center Department of Radiology
김평화 ( Kim Pyeong-Hwa ) - University of Ulsan College of Medicine Asan Medical Center Department of Radiology
김소연 ( Kim So-Yeon ) - University of Ulsan College of Medicine Asan Medical Center Department of Radiology
권동일 ( Gwon Dong-Il ) - University of Ulsan College of Medicine Asan Medical Center Department of Radiology
 ( Chu Hee-Ho ) - University of Ulsan College of Medicine Asan Medical Center Department of Radiology
박민호 ( Park Min-Ho ) - University of Ulsan College of Medicine Asan Medical Center Department of Radiology
허준호 ( Hur Joon-Ho ) - University of Ulsan College of Medicine Asan Medical Center Department of Radiology
김진영 ( Kim Jin-Young ) - University of Ulsan College of Medicine Asan Medical Center Department of Radiology
김동준 ( Kim Dong-Joon ) - University of Ulsan College of Medicine Asan Medical Center Department of Clinical Epidemiology and Biostatistics

Abstract


Objective: Clinical outcomes of patients who undergo transarterial chemoembolization (TACE) for single small hepatocellular carcinoma (HCC) are not consistent, and may differ based on certain imaging findings. This retrospective study was aimed at determining the efficacy of pre-TACE CT or MR imaging findings in predicting survival outcomes in patients with small HCC upon being treated with TACE. Besides, the study proposed to build a risk prediction model for these patients.

Materials and Methods: Altogether, 750 patients with functionally good hepatic reserve who received TACE as the first-line treatment for single small HCC between 2004 and 2014 were included in the study. These patients were randomly assigned into training (n = 525) and validation (n = 225) sets.

Results: According to the results of a multivariable Cox analysis, three pre-TACE imaging findings (tumor margin, tumor location, enhancement pattern) and two clinical factors (age, serum albumin level) were selected and scored to create predictive models for overall, local tumor progression (LTP)-free, and progression-free survival in the training set. The median overall survival time in the validation set were 137.5 months, 76.1 months, and 44.0 months for low-, intermediate-, and high-risk groups, respectively (p < 0.001). Time-dependent receiver operating characteristic curves of the predictive models for overall, LTP-free, and progression-free survival applied to the validation cohort showed acceptable areas under the curve values (0.734, 0.802, and 0.775 for overall survival; 0.738, 0.789, and 0.791 for LTP-free survival; and 0.671, 0.733, and 0.694 for progression-free survival at 3, 5, and 10 years, respectively).

Conclusion: Pre-TACE CT or MR imaging findings could predict survival outcomes in patients with small HCC upon treatment with TACE. Our predictive models including three imaging predictors could be helpful in prognostication, identification, and selection of suitable candidates for TACE in patients with single small HCC.

키워드

Hepatocellular carcinoma; Transarterial chemoembolization; Computed tomography imaging; Magnetic resonance imaging; Survival

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