Key MRI Findings Predictive of Treatment Response for Unresectable Hepatocellular Carcinoma

Ascites and LI-RADS tumor in vein on pre-treatment magnetic response imaging (MRI) were predictive of significantly poor response to the combination of transcatheter arterial chemoembolization (TACE) and targeted immunotherapy for unresectable hepatocellular carcinoma (uHCC), according to a new study.

For the retrospective study, recently published in the European Journal of Radiology, researchers reviewed baseline MRI data for 134 patients (mean age of 55.29) with uHCC who underwent TACE combined with targeted therapy and immunotherapy (TTI). The majority of the cohort (91.1 percent) had hepatitis-B virus (HBV)-related liver disease, according to the study.

In the multivariable analysis, the researchers found that the presence of LI-RADS tumor in vein (LR-TIV) and ascites on pre-treatment MRI were associated with an 86.2 percent and 63.1 percent, respectively, lower likelihood of response to TTI.

“These features, readily identifiable on baseline MRI, may reflect more aggressive tumor biology and reduced therapeutic efficacy,” wrote lead study author Lan Yanfen, M.D., who is affiliated with the Department of Oncology and Vascular Intervention at the Clinical Oncology School of Fujian Medical University in Fujan Cancer Hospital in Fujian, China, and colleagues.

The study authors also found that objective response to modified response evaluation criteria in solid tumors (OR-mRECIST) and enhancing pseudocapsule on MRI were associated with a 72.2 percent and 50 percent increased likelihood, respectively, of progression-free survival (PFS).

“Beyond its diagnostic value, the pseudocapsule may act as a barrier limiting tumor spread and facilitating embolization during TACE, thereby contributing to better local control and PFS,” added Yanfen and colleagues.

While acknowledging the need for future multicenter research and larger cohorts, the researchers emphasized that LI-RADS MRI-based risk prediction models can bolster risk stratification for patients with uHCC.

“These findings highlight the potential of MRI biomarkers in guiding personalized therapeutic strategies and improving patient outcomes in advanced HCC,” noted Yanfen and colleagues.

(Editor’s note: For related content, see “Could an Emerging PET Tracer be a Game Changer for Detecting Hepatocellular Carcinoma?,” “Seven Takeaways from New Literature Review on Ultrasound and Hepatocellular Carcinoma” and “Are CT and MRI-Derived LI-RADS Assessments Effective for Detecting HCC in Cases of Non-Cirrhotic Chronic Hepatitis C?”)

Beyond the inherent limitations of a single-center retrospective study, the study authors acknowledged the small cohort size and a lack of assessment for dynamic changes. Noting that the majority of patients with uHCC were not surgical candidates, the researchers conceded limited pathological confirmation.