Contrast-enhanced ultrasound in predicting complete remission of hepatocellular carcinoma after transcatheter arterial chemoembolization

Abstract

Abstract: Objective To investigate contrast-enhanced ultrasound (CEUS) in predicting the clinical remission of hepatocellular carcinoma (HCC) after transcatheter arterial chemoembolization (TACE). Methods A total of 46 patients (40 males and 6 females) who underwent CEUS after TACE from June 2019 to July 2021 were enrolled, with an average of 56 (41, 68) years. The efficacy of TACE was recorded according to the evaluation criteria of efficacy (RECIST), in which no blood flow or enhancement signal in the focus was defined as complete remission (CR), and the rest were non-CR. The general data of CR and non-CR cases were compared. The risk factors affecting the remission of lesions after TACE in HCC patients were analyzed, and evaluate the diagnostic value of CEUS. Results A total of 46 lesions were observed in 46 HCC cases, including 16 cases of CR (CR group) and 30 cases of non-CR (non-CR group). The tumor diameter of CR group was 2.5 (1.5, 4.0) cm, which was significantly smaller than that of non-CR group [4.5 (3.0, 6.5) cm, Z=11.028, P<0.05]. The proportions of arterial phase enhancement and annular enhancement in CR group were 7 cases (43.8%) and 2 cases (12.5%), which were significantly different from those in non-CR group [26 cases (86.7%) and 17 cases (56.7%)], the differences were statistically significant (χ²=-9.480, χ²=-8.496, P<0.05). The thickness of annular enhancement in CR group was 0.0 (0.0,0.0) cm, which was significantly lower than that in non-CR group [0.3 (0.0, 0.7) cm, Z=-9.004, P<0.05]. Tumor diameter, arterial enhancement, annular enhancement and annular enhancement thickness were taken as independent variables, remission of HCC patients after TACE treatment was taken as dependent variable (assigned 0 = CR, 1= no CR). The results of logistic regression indicated that tumor diameter, annular enhancement and annular enhancement thickness were independent predictors for incomplete remission in HCC patients after TACE treatment (P<0.05). Taking the results of digital subtraction angiography (DSA) or liver biopsy as the gold standard, the sensitivity, specificity, accuracy, positive predictive value and negative predictive value of CEUS in diagnosing CR were 81.2% (13/16), 93.3% (28/30), 89.1% (41/46) and 86.7% (13/15), respectively. Conclusion CEUS can be used to predict the CR of HCC patients after TACE. Tumor diameter, annular enhancement and annular enhancement thickness are independent risk factors.

Key words: Hepatocellular carcinoma, Transcatheter arterial chemoembolization, Contrast-enhanced ultrasound

GAO Xin-xuan, ZHEN Yan-hua, LI Hui-xia. Contrast-enhanced ultrasound in predicting complete remission of hepatocellular carcinoma after transcatheter arterial chemoembolization[J]. Chinese Hepatolgy, 2022, 27(10): 1084-1087.

References

[1] Wang DX, Yang X, Lin JZ, et al. Efficacy and safety of lenvatinib for patients with advanced hepatocellular carcinoma: A retrospective, real-world study conducted in China. World J Gastroenterol, 2020, 26(30):4465-4478.
[2] Xu XF, Xing H, Han J, et al. Risk factors, patterns, and outcomes of late recurrence after liver resection for hepatocellular carcinoma: a multicenter study from China. JAMA Surg, 2019, 154(3):209-217.
[3] Zhu J, Yin T, Xu Y, et al. Therapeutics for advanced hepatocellular carcinoma: Recent advances, current dilemma, and future directions. J Cell Physiol, 2019, 234(8):12122-12132.
[4] Raoul JL, Forner A, Bolondi L, et al. Updated use of TACE for hepatocellular carcinoma treatment: How and when to use it based on clinical evidence. Cancer Treat Rev, 2019, 72:28-36.
[5] Han K, Kim JH. Transarterial chemoembolization in hepatocellular carcinoma treatment: Barcelona clinic liver cancer staging system. World J Gastroenterol, 2015, 21(36):10327-10335.
[6] Yang Z, Chen G, Cui Y, et al. The safety and efficacy of TACE combined with apatinib on patients with advanced hepatocellular carcinoma: a retrospective study. Cancer Biol Ther, 2019, 20(3):321-327.
[7] Liu Q, Dai Y. Sorafenib combined with transarterial chemoembolization prolongs survival of patients with advanced hepatocellular carcinoma. J BUON, 2020, 25(2):945-951.
[8] Barr RG, Huang P, Luo Y, et al. Contrast-enhanced ultrasound imaging of the liver: a review of the clinical evidence for SonoVue and Sonazoid. Abdom Radiol (NY), 2020, 45(11):3779-3788.
[9] Ren J, Wu T, Zheng BW, et al. Application of contrast-enhanced ultrasound after liver transplantation: Current status and perspectives. World J Gastroenterol, 2016, 22(4):1607-1616.
[10] Dong Y, Zhang XL, Mao F, et al. Contrast-enhanced ultrasound features of histologically proven small (≤20 mm) liver metastases. Scand J Gastroenterol, 2017, 52(1):23-28.
[11] Eisenhauer EA, Therasse P, Bogaerts J, et al. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer, 2009, 45(2):228-247.
[12] Maruyama H, Kobayashi S, Yoshizumi H, et al. Application of percutaneous ultrasound-guided treatment for ultrasonically invisible hypervascular hepatocellular carcinoma using microbubble contrast agent. Clin Radiol, 2007, 62(7):668-675.
[13] Youk JH, Lee JM, Kim CS. Therapeutic response evaluation of malignant hepatic masses treated by interventional procedures with contrast-enhanced agent detection imaging. J Ultrasound Med, 2003, 22(9):911-920.
[14] 张心荣, 欧阳骏, 黄敬垣. CEUS和增强CT对原发性肝癌TACE术后疗效的评估价值比较. 世界华人消化杂志, 2019, 27(1): 63-67.
[15] Watanabe Y, Ogawa M, Kumagawa M, et al. Utility of contrast-enhanced ultrasound for early therapeutic evaluation of hepatocellular carcinoma after transcatheter arterial chemoembolization. J Ultrasound Med, 2020, 39(3):431-440.