Brief Article
Copyright ©2010 Baishideng. All rights reserved.
World J Gastroenterol. Apr 28, 2010; 16(16): 2038-2045
Published online Apr 28, 2010. doi: 10.3748/wjg.v16.i16.2038
CT volume measurement for prognostic evaluation of unresectable hepatocellular carcinoma after TACE
Jia-Wen Zhang, Xiao-Yuan Feng, Han-Qiu Liu, Zhen-Wei Yao, Yan-Mei Yang, Bin Liu, Yong-Qiang Yu
Jia-Wen Zhang, Xiao-Yuan Feng, Han-Qiu Liu, Zhen-Wei Yao, Yan-Mei Yang, Department of Radiology, Huashan Hospital of Fudan University, Shanghai 200040, China
Bin Liu, Yong-Qiang Yu, Department of Radiology, First Affiliated Hospital of Anhui Medical University, Hefei 200040, Anhui Province, China
Author contributions: Zhang JW, Liu B and Feng XY performed the majority of this study; Liu HQ, Yao ZW and Yang YM were involved in literature research and analysis of data; Zhang JW, Liu B and Yu YQ provided the collection of all clinical materials and data; Zhang JW and Feng XY designed the study, wrote the manuscript and revised the article.
Correspondence to: Xiao-Yuan Feng, Professor, Department of Radiology, Huashan Hospital of Fudan University, Wulumuqi Middle Road 12, Shanghai 200040, China.
Telephone: +86-21-52888685 Fax: +86-21-62496899
Received: December 7, 2009
Revised: February 6, 2010
Accepted: February 13, 2010
Published online: April 28, 2010

AIM: To analyze the value of computed tomography (CT) volume measurements for evaluation of the survival rate of unresectable hepatocellular carcinoma (HCC) patients after transcatheter arterial chemoembolization (TACE).

METHODS: One hundred and sixty-six unresectable HCC patients after TACE were involved in this retrospective study. Hepatic CT scan was performed for all patients before and 4 wk to 2 mo after TACE to define the morphologic features of HCC including its largest diameter, volume, product of the greatest axial dimension, tumor to liver volume ratio (TTLVR), and tumor shrinkage ratio. Clinical variables used in the study included gender, age, pattern of tumor growth, number of lesions, Child-Pugh classification of liver function, repeated TACE times, pre- or post-treatment α-fetoprotein (AFP) level, portal vein cancerous thrombus, tumor metastasis, degree of lipiodol retention within the tumor, and percutaneous ethanol injection. The correlation between survival time and clinical variables of patients or lesions was analyzed by combining morphologic features with the corresponding clinical and general data as input. A Cox proportional hazard model was used to analyze prognostic factors. The Kaplan-Meier method was used to calculate the cumulative survival time. Influence of the parameters on prognosis was analyzed by the log-rank test.

RESULTS: The overall 6, 12, 24, 36 and 60 mo cumulative survival rates were 78.92%, 49.85%, 23.82%, 15.60% and 8.92%, respectively. The median survival time was 12 mo. Univariate and multivariate analysis showed that only 4 parameters were the independent prognostic factors including TTLVR (χ2 = 14.328, P < 0.001), portal vein cancerous thrombus (χ2 = 5.643, P = 0.018), repeated TACE times (χ2 = 8.746, P = 0.003), and post-treatment serum AFP level (χ2 = 5.416, P = 0.020). When the TTLVR value was less than 70%, the survival time was inversely correlated with the TTLVR value.

CONCLUSION: CT volume measurement technique can predict the prognosis of unresectable HCC patients after TACE.

Keywords: Hepatocellular carcinoma, Chemoembolization, Tumor volume, Computed tomography, Prognosis