Quantitative MR Imaging Biomarkers Optimizes Staging System for TACE in HCC Patients

A retrospective study published in Radiology reports that the use of an MR-based, three-dimensional, quantitative tumor burden measurements identified patients who would benefit from transarterial chemoembolization (TACE). Further, the enhancement-based volumetric quantification of the patients’ tumor burden reliably served as a predictive imaging biomarker for overall survival.

The study included 494 patients with intermediate- to advanced-stage hepatocellular carcinoma who underwent conventional transarterial chemoembolization (TACE) or TACE with drug-eluting beads as first-line therapy. Barcelona Clinic Liver Cancer (BCLC) stages were determined by rereviewing the imaging, laboratory, and hepatic functional parameters from prior MRI data. Using semiautomatic tumor segmentation software and quantitative European Association for the Study of the Liver software, total liver and tumor volume, enhancing tumor volume (ETV, in cubic centimeters), and enhancing tumor burden (ETB, in percentages) were obtained at baseline MRI.

Patients were substratified with intermediate- and advanced-stage hepatocellular carcinoma according to three-dimensional quantitative tumor burden. The study also identified patients with a survival benefit from TACE before therapy. Specifically, the authors report that patients with Barcelona Clinic Liver Cancer (BCLC) B tumors may benefit from TACE regardless of the extent of tumor burden. Patients with BCLC C tumors with low viable tumor burden with an enhancing tumor volume of less than 65 cm3 or enhancing tumor burden of less than 4% show a survival benefit when treated with TACE, whereas patients with a large viable tumor burden do not benefit from TACE.

The authors conclude, “Our findings demonstrate that restratification of patients initially classified as having Barcelona Clinic Liver Cancer B- or C-stage hepatocellular carcinoma (HCC), ac-cording to enhancement-based, three-dimensional, quantitative tumor burden measurements, reliably differentiated between those who stand to benefit from transarterial chemoembolization and those with poor postprocedural outcome, particularly in advanced-stage disease. These findings demonstrate the potential application of this imaging biomarker as a triage tool for improved patient selection for transarterial locoregional therapy for HCC.”