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

• Published in: Current oncology (Toronto) 2022-05, Vol.29 (5), p.3259-3271
• Main Authors: Chuma, Makoto, Yokoo, Hideki, Hiraoka, Atsushi, Ueda, Kazuhiko, Yokoyama, Takahiro, Tsuji, Kunihiko, Shimada, Noritomo, Uojima, Haruki, Kobayashi, Satoshi, Hattori, Nobuhiro, Okubo, Tomomi, Atsukawa, Masanori, Ishikawa, Toru, Takaguchi, Koichi, Tsutsui, Akemi, Toyoda, Hidenori, Tada, Toshifumi, Saito, Yoshinori, Hirose, Shunji, Tanaka, Takaaki, Takeda, Kazuhisa, Otani, Masako, Sekikawa, Zenjiro, Watanabe, Tsunamasa, Hidaka, Hisashi, Morimoto, Manabu, Numata, Kazushi, Kagawa, Tatehiro, Sakamoto, Michiie, Kumada, Takashi, Maeda, Shin
• Format: Article
• Language: English
• Subjects: Carcinoma, Hepatocellular - diagnostic imaging; Carcinoma, Hepatocellular - drug therapy; complete response; CT value; hepatocellular carcinoma; Humans; lenvatinib; Liver Neoplasms - diagnostic imaging; Liver Neoplasms - drug therapy; molecular targeted agents; Necrosis; Phenylurea Compounds; Quinolines; Tomography, X-Ray Computed - methods
• ISSN: 1718-7729; 1198-0052; 1718-7729
• DOI: 10.3390/curroncol29050266

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% might be a predictor of maintenance of CR. Use of these indicators have the potential to impact systemic chemotherapy for HCC.