3:09 PM Abstract No. 272 Imaging predictors for tumor response to drug-eluting bead transarterial chemoembolization in patients with advanced hepatocellular carcinoma

To determine which imaging predictors are associated with treatment response of drug-eluting bead transarterial chemoembolization (DEB-TACE) in patients with advanced hepatocellular carcinoma (HCC). We performed a retrospective review of 177 HCC patients treated with DEB-TACE from October 2013 to December 2016, and 55 (31%) were Barcelona Clinic Liver Cancer stage C, defined as advanced HCCs. Of these advanced HCCs, we further excluded patients who received prior locoregional therapy (n = 8), systemic therapy (n = 2) and loss of follow-up (n = 1). Demographics data, laboratory results, tumor characteristics (size, number), imaging features at the baseline and at 3-month, 6-month post-TACE, and angiographic features were recorded. HCC tumor response to DEB-TACE was quantified via the modified Response Evaluation Criteria in Solid Tumors criteria. HCC lesions were classified into responder (complete and partial response) and non-responder (stable condition and disease progression) groups. Univariate and multivariable analyses were then constructed. Kappa coefficient of agreement was used to assess interobserver variability. A total of 71 HCCs in 44 patients received DEB-TACE, including responder (n = 48, 67.6%) and non-responder (n = 23, 32.4%). Multivariate analysis demonstrated that responder was associated with strong tumor enhancement (odds ratio [OR] = 4.5; p = .007), tumor burden < 50% liver volume (OR = 16.9; p = .03) on pre-TACE arterial phase images; and presence of a hypervascular tumor stain (OR = 3.5; p = .03), a feeding artery greater or equal to microcatheter diameter (OR = 3.0; p = .05), absence of intrahepatic vascular shunts (OR = 3.5; p = .03) on the pre-TACE angiogram. On post-TACE images, lack of residual enhancement with extensive cystic change (OR = 15.7; p = .0007) and decreased tumor size ≥ 20% (OR = 16.9; p = .0002) also predicted tumor response to DEB-TACE. All categorical measurements reached substantial to almost perfect agreement (0.65∼0.87). We found some imaging characteristics of advanced HCC that could predict a promising treatment response of DEB-TACE. These findings may give interventional radiologists confidence in treating advanced HCC.