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

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 le...

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Autores principales: 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
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9139739/
https://www.ncbi.nlm.nih.gov/pubmed/35621656
http://dx.doi.org/10.3390/curroncol29050266
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author 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
author_facet 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
author_sort Chuma, Makoto
collection PubMed
description 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%) N30-CTav group (p < 0.001, 61.5% at 1 year). Conclusion: The cut-off value of 30.2 HU for CTav (N30-CTav) might be appropriate for identifying post-lenvatinib necrosis in HCC, and an N30-CTav occupancy rate of >30.6% might be a predictor of maintenance of CR. Use of these indicators have the potential to impact systemic chemotherapy for HCC.
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spelling pubmed-91397392022-05-28 Identification of CT Values That Could Be Predictive of Necrosis (N-CTav) in Hepatocellular Carcinoma after Lenvatinib Treatment 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 Curr Oncol Article 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%) N30-CTav group (p < 0.001, 61.5% at 1 year). Conclusion: The cut-off value of 30.2 HU for CTav (N30-CTav) might be appropriate for identifying post-lenvatinib necrosis in HCC, and an N30-CTav occupancy rate of >30.6% might be a predictor of maintenance of CR. Use of these indicators have the potential to impact systemic chemotherapy for HCC. MDPI 2022-05-04 /pmc/articles/PMC9139739/ /pubmed/35621656 http://dx.doi.org/10.3390/curroncol29050266 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
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
Identification of CT Values That Could Be Predictive of Necrosis (N-CTav) in Hepatocellular Carcinoma after Lenvatinib Treatment
title Identification of CT Values That Could Be Predictive of Necrosis (N-CTav) in Hepatocellular Carcinoma after Lenvatinib Treatment
title_full Identification of CT Values That Could Be Predictive of Necrosis (N-CTav) in Hepatocellular Carcinoma after Lenvatinib Treatment
title_fullStr Identification of CT Values That Could Be Predictive of Necrosis (N-CTav) in Hepatocellular Carcinoma after Lenvatinib Treatment
title_full_unstemmed Identification of CT Values That Could Be Predictive of Necrosis (N-CTav) in Hepatocellular Carcinoma after Lenvatinib Treatment
title_short Identification of CT Values That Could Be Predictive of Necrosis (N-CTav) in Hepatocellular Carcinoma after Lenvatinib Treatment
title_sort identification of ct values that could be predictive of necrosis (n-ctav) in hepatocellular carcinoma after lenvatinib treatment
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9139739/
https://www.ncbi.nlm.nih.gov/pubmed/35621656
http://dx.doi.org/10.3390/curroncol29050266
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