Integrating baseline MR imaging biomarkers into BCLC and CLIP improves overall survival prediction of patients with hepa
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HEPATOBILIARY-PANCREAS
Integrating baseline MR imaging biomarkers into BCLC and CLIP improves overall survival prediction of patients with hepatocellular carcinoma (HCC) Mounes Aliyari Ghasabeh 1 & Mohammadreza Shaghaghi 1 & Ankur Pandey 1 & Sanaz Ameli 1 & Bharath Ambale Venkatesh 1 & Angela Jacob 1 & Pallavi Pandey 1 & Bita Hazhirkarzar 1 & Yan Luo 1,2 & Roya Rezvani Habibabadi 1 & Pegah Khoshpouri 1 & Maryam Ghadimi 1 & Ihab R. Kamel 1 Received: 23 April 2020 / Revised: 21 July 2020 / Accepted: 31 August 2020 # European Society of Radiology 2020
Abstract Objectives We aimed to evaluate the independent predictive role of baseline imaging biomarkers for overall survival (OS) and transplant-free survival (TFS) in patients with HCC and assess the incremental value of these biomarkers to current staging systems. Methods In this retrospective IRB approved study, the clinical, laboratory, and imaging parameters of 304 HCC patients were collected. Cox regression model was utilized to identify the potential predictors of survival. Recursive partitioning test was utilized to identify the optimal ADC cutoff for stratifying patients’ OS. Patients were stratified based on Barcelona Clinic Liver Cancer (BCLC) and Cancer of the Liver Italian Program (CLIP). Binary ADC value (above vs. below the cutoff) and tumor margin (well- vs. ill-defined) were integrated into BCLC and CLIP. OS and TFS was compared for patients based on standard criteria with and without imaging biomarkers. Results At baseline, patients with low tumor ADC and well-defined tumor margin (favorable imaging biomarkers) had longer survival, as compared to those with high ADC and ill-defined tumor margin (unfavorable imaging biomarkers) (median OS of 43 months vs. 7 months, respectively) (p < 0.001). Tumor ADC and tumor margin remained strong independent predictors of survival after adjustment for demographics, BCLC and CLIP staging, and tumor burden. Incorporating ADC and tumor margin improved performance of OS prediction by 9% in BCLC group and 6% in CLIP group. Conclusion Incorporating ADC and tumor margin to current staging systems for HCC significantly improve prediction of OS and TFS of these criteria. Key Points • ADC and tumor margin are predictors of overall survival in HCC patients, independent of clinical, laboratory, and other imaging variables. • Adding ADC and tumor margin improved the prognostic value of BCLC and CLIP criteria by 9% and 6%, respectively. • High ADC and ill-defined tumor margin at baseline predicted poor survival, regardless of patient’s liver function and general health status. This work originated in: Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University, 600 N. Wolfe St, Baltimore, MD 21287 Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00330-020-07251-4) contains supplementary material, which is available to authorized users. * Ihab R. Kamel [email protected] 1
The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hop
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