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 TanakaKazuhisa Takeda, Masako Otani, Zenjiro Sekikawa, Tsunamasa Watanabe, Hisashi Hidaka, Manabu Morimoto, Kazushi Numata, Tatehiro Kagawa, Michiie Sakamoto, Takashi Kumada, Shin Maeda

Research output: Contribution to journalArticlepeer-review

Abstract

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 (<30.6%) N30-CTav group (p < 0.001, 61.5% at 1 year). Conclusion: The cut-off value of 30.2 HU for CTav (N30-CTav) might be appropriate for identifying post-lenvatinib necrosis in HCC, and an N30-CTav occupancy rate of >30.6% might be a predictor of maintenance of CR. Use of these indicators have the potential to impact systemic chemotherapy for HCC.

Original languageEnglish
Article number3259
JournalCurrent Oncology
Volume29
Issue number5
DOIs
Publication statusPublished - 2022 May

Keywords

  • CT value
  • complete response
  • hepatocellular carcinoma
  • lenvatinib
  • molecular targeted agents

ASJC Scopus subject areas

  • Oncology

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