Influence of pre-treatment Tumour Growth Rate on objective response of hepatocellular carcinoma treated with transarterial chemoembolization

Yvonne Purcell, Riccardo Sartoris, Valérie Paradis, Valérie Vilgrain, Maxime Ronot
Journal of Gastroenterology and Hepatology 2019 August 1

INTRODUCTION: To assess the influence of pre-treatment Tumour Growth Rate (TGR) on mRECIST objective response (OR) after a first session of selective trans-arterial chemoembolization (TACE) for the treatment of hepatocellular carcinoma (HCC).

METHODS: 115 patients (101 men [88%], mean 65.1±10.5 years [range 26-87]) with 169 tumours (mean 34.2±29.3mm [10-160]), undergoing a first session of selective TACE for the treatment of HCC between 2011 and 2016, were included. TGR was calculated as the percentage change in tumour volume per month (%/mo) on imaging before treatment. TGR cut-off for prediction of OR was identified by ROC curve analysis.

RESULTS: Overall 88/189 (52%) and 46/189 (27%) tumours showed complete (CR) and partial response (PR) [OR rate 79%], while 32/189 (19%) showed stable disease (SD), and 3/189 (2%) were progressive disease (PD) on CT at 1-month post-TACE. The mean pretreatment TGR was 12.0±15.4 (-3.2-90.4) %/mo. TGR of tumours showing CR, PR, SD, and PD was a mean 13.2±16.4%, 12.1±15.1%, 5.3±4.5%, and 44.8±20.4%, respectively (p<0.001). The three tumours showing PD had TGR values >20%/mo. TGR was significantly higher in tumours with OR (12.8±15.9% vs. 5.3±4.5% in SD, p=0.009). A cut-off value of 6.5%/mo had the highest predictive value of OR (AUROC 0.65±0.05, p=0.009).

CONCLUSION: Pre-treatment TGR is highly variable in HCC before TACE with a U-shaped distribution for the prediction of tumour response. It provides insight into tumour biology that may be used during pre-treatment workup to help stratify patients.

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