Current Oncology (May 2022)

Identification of CT Values That Could Be Predictive of Necrosis (N-CTav) in Hepatocellular Carcinoma after Lenvatinib Treatment

  • Makoto Chuma,
  • Hideki Yokoo,
  • Atsushi Hiraoka,
  • Kazuhiko Ueda,
  • Takahiro Yokoyama,
  • Kunihiko Tsuji,
  • Noritomo Shimada,
  • Haruki Uojima,
  • Satoshi Kobayashi,
  • Nobuhiro Hattori,
  • Tomomi Okubo,
  • Masanori Atsukawa,
  • Toru Ishikawa,
  • Koichi Takaguchi,
  • Akemi Tsutsui,
  • Hidenori Toyoda,
  • Toshifumi Tada,
  • Yoshinori Saito,
  • Shunji Hirose,
  • Takaaki Tanaka,
  • Kazuhisa Takeda,
  • Masako Otani,
  • Zenjiro Sekikawa,
  • Tsunamasa Watanabe,
  • Hisashi Hidaka,
  • Manabu Morimoto,
  • Kazushi Numata,
  • Tatehiro Kagawa,
  • Michiie Sakamoto,
  • Takashi Kumada,
  • Shin Maeda

DOI
https://doi.org/10.3390/curroncol29050266
Journal volume & issue
Vol. 29, no. 5
pp. 3259 – 3271

Abstract

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Purpose: To assess the utility of measurement of the computed tomography (CT) attenuation value (CTav) in predicting tumor necrosis in hepatocellular carcinoma (HCC) patients who achieve a complete response (CR), defined using modified Response Evaluation Criteria in Solid Tumors (mRECIST), after lenvatinib treatment. Method: We compared CTav in arterial phase CT images with postoperative histopathology in four patients who underwent HCC resection after lenvatinib treatment, to determine CTav thresholds indicative of histological necrosis (N-CTav). Next, we confirmed the accuracy of the determined N-CTav in 15 cases with histopathologically proven necrosis in surgical specimens. Furthermore, the percentage of the tumor with N-CTav, i.e., the N-CTav occupancy rate, assessed using Image J software in 30 tumors in 12 patients with CR out of 571 HCC patients treated with lenvatinib, and its correlation with local recurrence following CR were examined. Results: Receiver operating characteristic (ROC) curve analysis revealed an optimal cut-off value of CTav of 30.2 HU, with 90.0% specificity and 65.0% sensitivity in discriminating between pathologically identified necrosis and degeneration, with a CTav of less than 30.2 HU indicating necrosis after lenvatinib treatment (N30-CTav). Furthermore, the optimal cut-off value of 30.6% for the N30-CTav occupancy rate by ROC analysis was a significant indicator of local recurrence following CR with 76.9% specificity and sensitivity (area under the ROC curve; 0.939), with the CR group with high N30-CTav occupancy (≥30.6%) after lenvatinib treatment showing significantly lower local recurrence (8.3% at 1 year) compared with the low (p 30.6% might be a predictor of maintenance of CR. Use of these indicators have the potential to impact systemic chemotherapy for HCC.

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