1Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
2Department of Gastroenterology, Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
3Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
Copyright © 2024 by the Korean Cancer Association
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Ethical Statement
The study protocol was in accordance with the guidelines of the Declaration of Helsinki and was approved by the Institutional Review Board of Asan Medical Center (approval no.: 2022-0101), which waived the requirement for informed patient consent due to the retrospective nature of this study.
Author Contributions
Conceived and designed the analysis: Choi SH, Choi WM.
Collected the data: Choi J, Kim KM, Kim HF, Yoo C, Ryoo BY.
Contributed data or analysis tools: Choi SJ, Chung SW.
Performed the analysis: Choi SJ, Chung SW.
Wrote the paper: Choi SJ, Chung SW, Choi J, Kim KM, Kim HD, Yoo C, Ryoo BY, Lee SS, Choi SH, Choi WM.
Visualization: Lee SS.
Conflict of Interest
Conflict of interest relevant to this article was not reported.
Values are resented as mean±SD, median (IQR), or number (%). AFP, α-fetoprotein; ALBI, albumin-bilirubin; BCLC, Barcelona Clinic Liver Cancer; ECOG, Eastern Cooperative Oncology Group; HBV, hepatitis B virus; HCV, hepatitis C virus; INR, international normalized ratio; IQR, interquartile range; PIVKAII, protein induced by vitamin K absence or antagonist-II; RT, radiation therapy; SD, standard deviation; TACE, transarterial chemoembolization.
AFP, α-fetoprotein; ALBI, albumin-bilirubin; APHE, arterial-phase hyperenhancement; BCLC, Barcelona Clinic Liver Cancer; CI, confidence interval; ECOG, Eastern Cooperative Oncology Group; HBV, hepatitis B virus; OR, odds ratio; PIVKA-II, protein induced by vitamin K absence or antagonist-II; RT, radiation therapy; TACE, transarterial chemoembolization.
Variable | Value |
---|---|
Age (yr) | 58±12 |
Sex | |
Men | 95 (88.0) |
Women | 13 (12.0) |
Etiology | |
HBV | 77 (71.3) |
HCV | 6 (5.6) |
Others | 25 (23.1) |
Child-Pugh class | |
A | 55 (50.9) |
B | 53 (49.1) |
ECOG performance status | |
0 | 11 (10.2) |
1 | 94 (87.0) |
2 | 3 (2.8) |
Ascites | 10 (9.3) |
Pleural effusion | 10 (9.3) |
Prior treatment | |
Surgery | 28 (25.9) |
Ablation | 13 (12.0) |
TACE | 69 (63.9) |
RT | 41 (38.0) |
BCLC stage | |
Intermediate | 7 (6.5) |
Advanced | 101 (93.5) |
Extrahepatic metastasis | 80 (74.1) |
Involved organ | |
Lung | 54 (50.0) |
Bone | 17 (15.7) |
Lymph node | 26 (24.1) |
Multiorgan metastases | 25 (23.2) |
Laboratory data | |
Albumin (g/dL) | 3.5 (3.2, 3.9) |
Bilirubin (g/dL) | 0.8 (0.5, 1.1) |
INR | 1.1 (1.0, 1.2) |
ALBI grade | |
Grade 1 | 21 (19.4) |
Grade 2 | 83 (76.9) |
Grade 3 | 4 (3.7) |
Tumor markers | |
AFP (ng/mL) | 359 (15-4,463) |
PIVKA-II (mAU/mL) | 784 (121-7,587) |
Variable | PD (n=40) | Non-PD (n=68) | p-value |
---|---|---|---|
Tumor size (cm) | 9.9±5.7 | 8.3±5.4 | 0.13 |
No. of involved segments | 4.7±2.5 | 4.4±2.8 | 0.69 |
Tumor margin | |||
Smooth | 13 (32.5) | 31 (45.6) | 0.18 |
Nonsmooth | 27 (67.5) | 37 (54.4) | |
Infiltrative appearance | |||
Present | 18 (45.0) | 13 (19.1) | 0.005 |
Absent | 22 (55.0) | 55 (80.9) | |
APHE | |||
Present | 22 (55.0) | 60 (88.2) | < 0.001 |
Absent | 18 (45.0) | 8 (11.8) | |
Rim enhancement | |||
Present | 4 (10.0) | 4 (5.9) | 0.43 |
Absent | 36 (90.0) | 64 (94.1) | |
Washout appearance | |||
Present | 36 (90.0) | 53 (77.9) | 0.12 |
Absent | 4 (10.0) | 15 (22.1) | |
Intratumoral necrosis | |||
Present | 17 (42.5) | 28 (41.2) | 0.89 |
Absent | 23 (57.5) | 40 (58.8) | |
Peritumoral bile duct dilatation | |||
Present | 3 (7.5) | 7 (10.3) | 0.63 |
Absent | 37 (92.5) | 61 (89.7) | |
Tumor-in-vein | |||
Present | 28 (70.0) | 26 (38.2) | 0.002 |
Absent | 12 (30.0) | 42 (61.7) | |
Multifocality in liver | |||
Present | 29 (72.5) | 46 (67.6) | 0.60 |
Absent | 11 (27.5) | 22 (32.4) |
Variable | Univariable analysis |
Multivariable analysis |
||
---|---|---|---|---|
OR (95% CI) | p-value | OR (95% CI) | p-value | |
Age, per 1-year increase | 0.99 (0.96-1.03) | 0.72 | ||
Sex | ||||
Women | 1 (reference) | 0.28 | ||
Men | 2.13 (0.55-8.24) | |||
Etiology | ||||
Non-HBV | 1 (reference) | 0.83 | ||
HBV | 1.10 (0.46-2.62) | |||
Child-Pugh class | ||||
A | 1 (reference) | 0.52 | ||
B | 0.77 (0.35-1.69) | |||
ECOG performance | ||||
0 or 1 | 1 (reference) | 0.19 | ||
2 | 2.87 (0.59-14.03) | |||
Ascites | ||||
Present | 1.15 (0.30-4.34) | 0.84 | ||
Pleural effusion | ||||
Present | 1.80 (0.49-6.65) | 0.38 | ||
Prior treatment | ||||
Surgery | 1.39 (0.58-3.35) | 0.46 | ||
Ablation | 1.54 (0.48-4.95) | 0.47 | ||
TACE | 1.08 (0.48-2.44) | 0.85 | ||
RT | 1.60 (0.72-3.56) | 0.25 | ||
BCLC stage | ||||
B | 1 (reference) | 0.23 | ||
C | 3.77 (0.44-32.55) | |||
Extrahepatic metastasis | ||||
Present | 3.58 (1.24-10.36) | 0.02 | 4.13 (1.19-14.35) | 0.03 |
Involved organ | ||||
Lung | 2.65 (1.18-5.96) | 0.02 | ||
Bone | 2.18 (0.77-6.20) | 0.15 | ||
Lymph node | 1.08 (0.44-2.69) | 0.86 | ||
Multiorgan metastases | ||||
Present | 1.65 (0.68-4.05) | 0.27 | ||
ALBI grade | ||||
Grade 1 | 1 (reference) | 0.54 | ||
Grade 2 or 3 | 0.74 (0.28-1.95) | |||
AFP (ng/mL) | ||||
< 400 | 1 (reference) | 0.03 | ||
≥ 400 | 2.38 (1.07-5.31) | 1.55 (0.59-4.07) | 0.38 | |
PIVKA-II (mAU/mL) | ||||
< 2,000 | 1 (reference) | 0.10 | ||
≥ 2,000 | 1.93 (0.88-4.26) | |||
Tumor size, per 1 cm increase | 1.06 (0.98-1.13) | 0.13 | ||
No. of involved segments | 1.03 (0.89-1.20) | 0.69 | ||
Tumor margin | ||||
Smooth | 1 (reference) | 0.18 | ||
Nonsmooth | 1.74 (0.77-3.93) | |||
Infiltrative appearance | ||||
Present | 3.46 (1.45-8.25) | 0.005 | 3.07 (1.05-8.93) | 0.04 |
APHE | ||||
Absent | 6.14 (2.34-16.12) | < 0.001 | 6.34 (2.18-18.47) | < 0.001 |
Rim enhancement | ||||
Present | 1.88 (0.44-8.00) | 0.43 | ||
Washout appearance | ||||
Present | 2.55 (0.78-8.30) | 0.12 | ||
Intratumoral necrosis | ||||
Present | 1.06 (0.48-2.33) | 0.89 | ||
Peritumoral bile duct dilatation | ||||
Present | 0.71 (0.17-2.90) | 0.63 | ||
Tumor-in-vein | ||||
Present | 3.77 (1.64-8.68) | 0.002 | 2.07 (0.74-5.77) | 0.16 |
Multifocality in liver | ||||
Present | 1.26 (0.53-2.98) | 0.60 |
Treatment response | No. of significant predictive factors |
p-value | ||
---|---|---|---|---|
N=0 (n=18) | N=1 (n=51) | N ≥ 2 (n=39) | ||
Complete response | 1 | 0 | 1 | |
Partial response | 5 | 6 | 2 | |
Stable disease | 9 | 34 | 10 | |
Progressive disease | 3 | 11 | 26 | |
Disease control rate (%) | 83.3 | 78.4 | 33.3 | < 0.001 |
Values are resented as mean±SD, median (IQR), or number (%). AFP, α-fetoprotein; ALBI, albumin-bilirubin; BCLC, Barcelona Clinic Liver Cancer; ECOG, Eastern Cooperative Oncology Group; HBV, hepatitis B virus; HCV, hepatitis C virus; INR, international normalized ratio; IQR, interquartile range; PIVKAII, protein induced by vitamin K absence or antagonist-II; RT, radiation therapy; SD, standard deviation; TACE, transarterial chemoembolization.
Values are resented as mean±SD or number (%). APHE, arterial-phase hyperenhancement; PD, progressive disease; SD, standard deviation.
AFP, α-fetoprotein; ALBI, albumin-bilirubin; APHE, arterial-phase hyperenhancement; BCLC, Barcelona Clinic Liver Cancer; CI, confidence interval; ECOG, Eastern Cooperative Oncology Group; HBV, hepatitis B virus; OR, odds ratio; PIVKA-II, protein induced by vitamin K absence or antagonist-II; RT, radiation therapy; TACE, transarterial chemoembolization.