Yusuke Kawamura1,2, Masahiro Kobayashi1,2, Junichi Shindoh3,2, Yuta Kobayashi3,2, Kayoko Kasuya1,2, Tomoya Sano1,2, Shunichiro Fujiyama1,2, Tetsuya Hosaka1,2, Satoshi Saitoh1,2, Hitomi Sezaki1,2, Norio Akuta1,2, Fumitaka Suzuki1,2, Yoshiyuki Suzuki1,2, Kenji Ikeda1,2, Yasuji Arase1,2, Masaji Hashimoto3,2, Hiromitsu Kumada1,2
1Department of Hepatology, Toranomon Hospital, Tokyo, Japan
2Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
3Hepatobiliary-Pancreatic Surgery Division, Department of Gastroenterological Surgery, Toranomon Hospital, Tokyo, Japan
Tóm tắt
<b><i>Objective:</i></b> The aim of this study was to evaluate the performance of pretreatment computed tomography (CT) enhancement of hepatocellular carcinoma (HCC) as a potential predictor of response to lenvatinib and its relevance to survival outcomes. <b><i>Methods:</i></b> We evaluated 51 consecutive patients who received lenvatinib treatment for unresectable HCC. On imaging analysis, pretreatment arterial/portal phase dynamic CT images were classified as follows: type 2, homogeneous enhancement pattern with increased arterial blood flow; type 3, heterogeneous enhancement pattern with a septum-like structure; and type 4, heterogeneous enhancement pattern with irregularly shaped ring structures. Treatment response was evaluated using modified Response Evaluation Criteria in Solid Tumors at 2–12 weeks after initiation of lenvatinib, and the correlations between the CT enhancement patterns and response to lenvatinib or survival outcomes were investigated. <b><i>Results:</i></b> Of the 51 patients, 38 (75%) experienced an objective response (OR). ORs were significantly more common in heterogeneously enhanced HCC (types 3 and 4) than in homogeneous HCC (type 2) (83 vs. 53%, respectively; <i>p</i> = 0.037). Multivariate analysis revealed that pretreatment heterogeneous enhancement pattern is an independent predictor for response to lenvatinib (odds ratio, 4.75; <i>p</i> = 0.042). Presence of OR was associated with longer progression-free survival (PFS) (hazard ratio, 0.36; <i>p</i> = 0.017), and patients with oncologically aggressive type 3 and 4 tumors showed similar PFS to those harboring type 2 tumors (<i>p</i> = 0.455), reflecting that OR was more common in type 3 or 4 tumors compared with type 2 tumors. Although postprogression survival was extremely poor in patients with type 4 tumors (<i>p</i> = 0.064), overall survival after introduction of lenvatinib was not statistically different among the three groups of patients (<i>p</i> = 0.053). <b><i>Conclusion:</i></b> The CT enhancement pattern of HCC may predict response to lenvatinib. OR seems to occur more frequently in HCC with oncologically aggressive features and may contribute to prolonged survival through a prolonged progression-free interval, even in an oncologically poor-risk group of patients.
