TY - JOUR
T1 - Identification of CT Values That Could Be Predictive of Necrosis (N-CTav) in Hepatocellular Carcinoma after Lenvatinib Treatment
AU - Chuma, Makoto
AU - Yokoo, Hideki
AU - Hiraoka, Atsushi
AU - Ueda, Kazuhiko
AU - Yokoyama, Takahiro
AU - Tsuji, Kunihiko
AU - Shimada, Noritomo
AU - Uojima, Haruki
AU - Kobayashi, Satoshi
AU - Hattori, Nobuhiro
AU - Okubo, Tomomi
AU - Atsukawa, Masanori
AU - Ishikawa, Toru
AU - Takaguchi, Koichi
AU - Tsutsui, Akemi
AU - Toyoda, Hidenori
AU - Tada, Toshifumi
AU - Saito, Yoshinori
AU - Hirose, Shunji
AU - Tanaka, Takaaki
AU - Takeda, Kazuhisa
AU - Otani, Masako
AU - Sekikawa, Zenjiro
AU - Watanabe, Tsunamasa
AU - Hidaka, Hisashi
AU - Morimoto, Manabu
AU - Numata, Kazushi
AU - Kagawa, Tatehiro
AU - Sakamoto, Michiie
AU - Kumada, Takashi
AU - Maeda, Shin
N1 - Funding Information:
Conflicts of Interest: Makoto Chuma has received lecture fees from Chugai Pharmaceutical. Atsushi Hiraoka has received lecture fees from Chugai Pharmaceutical and Eli Lilly and Company, Hidenori Toyoda has received lecture fees from Bayer Yakuhin Ltd., AbbVie and MSD. Tatehiro Kagawa has received research funding from Eisai Co., Ltd. Michiie Sakamoto has received a designated contribution from Eisai Co., Ltd., and CYTLIMIC Inc. Takashi Kumada has received research grants from Gilead Sciences Inc., and lecture fees from Bristol-Myers-Squibb, AbbVie and Gilead Sciences Inc. The other authors have no conflicts of interest.
Funding Information:
Funding: JSPS KAKENHI: Grant/Award Number: 21K07899.
Publisher Copyright:
© 2022 by the authors. Licensee MDPI, Basel, Switzerland.
PY - 2022/5
Y1 - 2022/5
N2 - 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.
AB - 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.
KW - CT value
KW - complete response
KW - hepatocellular carcinoma
KW - lenvatinib
KW - molecular targeted agents
UR - http://www.scopus.com/inward/record.url?scp=85130060781&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85130060781&partnerID=8YFLogxK
U2 - 10.3390/curroncol29050266
DO - 10.3390/curroncol29050266
M3 - Article
C2 - 35621656
AN - SCOPUS:85130060781
SN - 1198-0052
VL - 29
SP - 3259
EP - 3271
JO - Current Oncology
JF - Current Oncology
IS - 5
M1 - 3259
ER -