LI-RADS treatment response algorithm after first-line DEB-TACE: reproducibility and prognostic value at initial
Ali Pirasteh1,2,3, E Aleks Sorra4, Hector Marquez4
1Radiology, University of Wisconsin-Madison, 1111 Highland Ave, WIMR II, Room 2423, Madison, WI, 53705, USA. pirasteh@wisc.edu.
The Liver Imaging Reporting and Data System (LI-RADS) treatment response algorithm (LR-TR) shows moderate reproducibility but doesn't predict overall survival after drug-eluting beads transarterial chemoembolization (DEB-TACE) for hepatocellular carcinoma (HCC). Modified Response Evaluation Criteria in Solid Tumors (mRECIST)-overall is a better predictor.
Area of Science:
- Hepatocellular Carcinoma (HCC) treatment response assessment
- Medical imaging and diagnostic algorithms
- Radiology and oncology
Background:
- Hepatocellular carcinoma (HCC) is a common primary liver cancer.
- Drug-eluting beads transarterial chemoembolization (DEB-TACE) is a standard first-line treatment for HCC.
- Accurate assessment of treatment response is crucial for patient management and prognosis.
Purpose of the Study:
- To evaluate the inter-reader reproducibility of the Liver Imaging Reporting and Data System (LI-RADS) treatment response algorithm (LR-TR).
- To assess the prognostic accuracy of LR-TR in predicting overall survival after DEB-TACE for HCC.
- To compare LR-TR with modified Response Evaluation Criteria in Solid Tumors (mRECIST) for treatment response evaluation.
Main Methods:
- Retrospective analysis of 82 patients with HCC treated with first-line DEB-TACE.
- Six readers independently assessed treatment response using LR-TR, mRECIST-target, and mRECIST-overall criteria on post-treatment CT/MRI.
- Inter-reader agreement was calculated using Fleiss' multi-reader κ; overall survival was analyzed using Kaplan-Meier and Cox models.
Main Results:
- Moderate inter-reader agreement was observed for LR-TR (κ range 0.42-0.57) and mRECIST-overall, while mRECIST-target showed substantial agreement (κ range 0.62-0.66).
- LR-TR and mRECIST-target response were not significantly associated with overall survival across all reader groups.
- mRECIST-overall response significantly predicted overall survival in experienced readers and all readers combined, but not in less-experienced readers.
Conclusions:
- The LR-TR algorithm demonstrates moderate inter-reader reproducibility but may not be sufficient alone for predicting overall survival post-DEB-TACE for HCC.
- mRECIST-overall criteria appear to be a more reliable predictor of overall survival in this context, particularly when assessed by experienced readers.
- Further refinement of imaging-based response assessment criteria for HCC after DEB-TACE is warranted.
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