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Baseline tumor Lipiodol uptake after transarterial chemoembolization for hepatocellular carcinoma: identification of a threshold value predicting tumor recurrence

Yusuke Matsui
Yusuke Matsui
, 
Masahiro Horikawa
Masahiro Horikawa
, 
Younes Jahangiri Noudeh
Younes Jahangiri Noudeh
, 
John A. Kaufman
John A. Kaufman
, 
Kenneth J. Kolbeck
Kenneth J. Kolbeck
 e 
Khashayar Farsad
Khashayar Farsad
   | 18 lug 2017
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Article Category: Research Article
Pubblicato online: 18 lug 2017
Pagine: 393 - 400
Ricevuto: 16 apr 2017
Accettato: 30 giu 2017
DOI: https://doi.org/10.1515/raon-2017-0030
© 2017 Yusuke Matsui, Masahiro Horikawa, Younes Jahangiri Noudeh, John A. Kaufman, Kenneth J. Kolbeck, Khashayar Farsad
This article is distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Figure 1

Baseline Lipiodol uptake after TACE for HCC. Significantly higher Lipiodol uptake was noted in tumors without recurrence and in tumors treated selectively with TACE.
Baseline Lipiodol uptake after TACE for HCC. Significantly higher Lipiodol uptake was noted in tumors without recurrence and in tumors treated selectively with TACE.

Figure 2

Baseline Lipiodol uptake and washout rate in relation to early tumor recurrence. Early recurring tumors demonstrated significantly lower baseline Lipiodol uptake and higher Lipiodol washout rates relative to tumors recurring after the median recurrence free interval (= 3 months) and tumors with no recurrence.
Baseline Lipiodol uptake and washout rate in relation to early tumor recurrence. Early recurring tumors demonstrated significantly lower baseline Lipiodol uptake and higher Lipiodol washout rates relative to tumors recurring after the median recurrence free interval (= 3 months) and tumors with no recurrence.

Figure 3

ROC curve showing the area under curve and optimal cutoff value of baseline Lipiodol uptake after TACE to predict tumor recurrence.
ROC curve showing the area under curve and optimal cutoff value of baseline Lipiodol uptake after TACE to predict tumor recurrence.

Figure 4

Comparison of the cumulative hazards of tumor recurrence over the follow-up period between baseline Lipiodol uptake above and below the identified threshold. Tumors with Lipiodol uptake < 270.2 HU demonstrated significantly higher hazards of recurrence after TACE.
Comparison of the cumulative hazards of tumor recurrence over the follow-up period between baseline Lipiodol uptake above and below the identified threshold. Tumors with Lipiodol uptake < 270.2 HU demonstrated significantly higher hazards of recurrence after TACE.

Figure 5

ROC curve showing the area under curve and optimal cutoff value of Lipiodol washout rate after TACE to predict early tumor recurrence.
ROC curve showing the area under curve and optimal cutoff value of Lipiodol washout rate after TACE to predict early tumor recurrence.

Figure 6

Comparison of the cumulative hazards of tumor recurrence over the follow-up period between Lipiodol washout rates above and below the identified threshold. Tumors with Lipiodol washout rates ≥ 37.8 HU/month demonstrated significantly higher hazards of recurrence after TACE.
Comparison of the cumulative hazards of tumor recurrence over the follow-up period between Lipiodol washout rates above and below the identified threshold. Tumors with Lipiodol washout rates ≥ 37.8 HU/month demonstrated significantly higher hazards of recurrence after TACE.

Summary of the study population

Characteristics
Patients
Age (years)59.9 ± 7.9
GenderFemale 12 (40.0%)
Male 18 (60.0%)
HCV 13 (43.3%)
HCV + Alcohol 7 (23.3%)
Liver disease etiologyAlcohol 4 (13.3%)
HBV 1 (3.3%)
Other 5 (16.7%)
Child-Pugh classA 10 (33.3%)
B 20 (66.7%)
BCLC stageA 17 (56.7%)
B 13 (43.3%)
Tumors
Baseline tumor size (mm) 20.3 ± 10.1
Lobar 16 (34.8%)
Treatment selectivitySegmental 22 (47.8%)
Sub-segmental 8 (17.4%)
Baseline Lipiodol uptake (HU) 328.3 ± 185.2
Lipiodol uptake at final evaluation (HU) 205.0 ± 219.5
Washout (HU) 136.9 ± 127.6
Follow-up time (months) 5.6 ± 6.2
Tumor recurrenceYes 19 (41.3%)
No 27 (58.7%)

Results of cox regression analysis to predict factors for tumor recurrence

Predicting factorUnivariate modelMultivariate model

Variables with a p value less than 0.200 were entered in the multivariate model.

Hazard ratio (CI)p ValueHazard ratio (CI)p Value
Lesion size (mm)0.70 (0.24-2.09)0.527--
Treatment selectivity (Segmental or subsegmental vs. lobar)0.19 (0.07–0.51)0.0013.05 (0.62–15.05)0.171
Baseline Lipiodol uptake (HU)0.37 (0.19–0.70)0.0020.002 (0.0–0.087)0.001
Presence of Lipiodol washoutNA

Not calculated because no tumors without Lipiodol washout recurred while 65.5% (19/29) of the tumors with Lipiodol washout recurred.

NA--
Washout rate (HU/month)3.37 (1.78–6.36)< 0.0001149.03 (11.20–1983.54)< 0.0001
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Lingua:
Inglese
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Medicine, Clinical Medicine, Internal Medicine, Haematology, Oncology, Radiology
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