CT volume of enhancement of disease (VED) can predict the early response to treatment and overall survival in patients with advanced HCC treated with sorafenib

OBJECTIVES: To analyse the predictive value of the volume of enhancement of disease (VED), based on the CT arterial enhancement coefficient (ΔArt%), in the evaluation of the sorafenib response in patients with advanced hepatocellular carcinoma (HCC). METHODS: Patients with sorafenib-treated advanced HCC, who underwent a multiphase contrast-enhanced CT before (T0) and after 60–70 days of starting therapy (T1), were included. The same target lesions utilised for the response evaluation according to modified Response Evaluation Criteria in Solid Tumors criteria were retrospectively used for the ΔArt% calculation ([(HU(arterial phase) − HU(unenhanced phase)) / HU(unenhanced phase)] × 100). ΔArt% was weighted for the lesion volume to obtain the VED. We compared VED(T0) and VED(T1) values in patients with clinical benefit (CB) or progressive disease (PD). The impact of VED, ancillary imaging findings, and blood chemistries on survival probability was evaluated. RESULTS: Thirty-two patients (25 men, mean age 65.8 years) analysed between 2012 and 2016 were selected. At T1, 8 patients had CB and 24 had PD. VED(T0) was > 70% in 8/8 CB patients compared with 12/24 PD patients (p = 0.011). Patients with VED(T0) > 70% showed a significantly higher median survival than those with lower VED(T0) (451.5 days vs. 209.5 days, p = 0.032). Patients with VED(T0) > 70% and alpha-fetoprotein(T0) ≤ 400 ng/ml had significantly longer survival than all other three combinations. In multivariate analysis, VED(T0) > 70% emerged as the only factor independently associated with survival (p = 0.037). CONCLUSION: In patients with advanced HCC treated with sorafenib, VED is a novel radiologic parameter obtained by contrast-enhanced CT, which could be helpful in selecting patients who are more likely to respond to sorafenib, and with a longer survival. KEY POINTS: • To achieve the best results of treatment with sorafenib in advanced HCC, a strict selection of patients is needed. • New radiologic parameters predictive of the response to sorafenib would be essential. • Volume of enhancement of disease (VED) is a novel radiologic parameter obtained by contrast-enhanced CT, which could be helpful in selecting patients who are more likely to respond to therapy, and with a longer survival.