ISSN 1305-3825 | E-ISSN 1305-3612
Interventional Radiology - Original Article
Evaluation of CT vascularization patterns for survival prognosis in patients with hepatocellular carcinoma treated by conventional TACE
1 Institutes of Diagnostic and Interventional Radiology, The Hannover Medical School, Hannover, Germany.  
2 Institute of Biometry, The Hannover Medical School, Hannover, Germany  
3 Department of Gastroenterology, Hepatology and Endocrinology, The Hannover Medical School, Hannover, Germany  
Diagn Interv Radiol ; : -
DOI: 10.5152/dir.2016.16006
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Introduction: Transarterial chemoembolization (TACE) is an established treatment for intermediate stage hepatocellular carcinoma (HCC). The aim of this retrospective study was to evaluate the power of lesion vascularization criteria based on computed tomography for prognosis of overall survival (OS) before initiation of treatment.


Material and Methods: 59 patients with intermediate stage HCC treated with TACE as first-line treatment were retrospectively evaluated. TACE procedures were performed using doxorubicin, cisplatin and lipiodol. Response evaluation criteria in solid tumours version 1.1 (RECIST1.1) were used to determine the initial tumour response. 4 vascularization patterns (VP) of the largest target lesion as reported by Kawamura et al. (homogenous vascularization without (VP1) and with additional arterial hypervascularization (VP2), heterogeneous vascularization with (VP3) and without zones of hypervascularization (VP4)) were assessed prior to the first TACE and correlated to survival.


Results: Kaplan-Meier analysis yielded a median OS of 608d (SE=120.528). Analysis of OS showed significant differences depending on the vascularization patterns (p=0.012, HR=0.327): patients with homogenously vascularised lesions (VP1-VP2) had a median OS of 1091d (SE=235.532). Patients with heterogeneous vascularization without (VP3) or with hypovascularization (VP4) of the lesion showed a median OS of 508d (SE=113.912).


Conclusion: The vascularization pattern of the largest HCC lesion is helpful for survival prognosis under TACE treatment and therefore has the potential to be used as an additional parameter for treatment stratification.

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