Preoperative MRI Features And Clinical Laboratory Indicators For Predicting The Early Therapeutic Response Of Hepatocellular Carcinoma To TACE Combined With HIFU Treatment

Objectives: To evaluate the value of preoperative magnetic resonance imaging(MRI)features and laboratory indicators in predicting the early response of hepatocellular carcinoma(HCC)to transcatheter arterial chemoembolization(TACE)combined with high-intensity focused ultrasound(HIFU)treatment and to establish a preoperative prediction model.Methods: A total of 188 patients with 223 tumors who underwent TACE/HIFU treatment from January 2011 to June 2017 were included.Tumors were divided into three groups(<2 cm,2-5 cm,>5 cm)and classified as non-complete response(NCR)and complete response(CR)cohorts according to the Response Evaluation Criteria in Cancer of the Liver(RECICL)2015 revised version.Univariate analysis and multivariate logistic regression analysis were used to determine independent predictors,and receiver operating characteristic(ROC)curve analysis was performed and the area under the curve(AUC)was calculated to assess the diagnostic power of each predictor,the sensitivity,specificity,positive predictivevalue(PPV),and negative predictive value(NPV)of predictors were also calculated.The score of each valuable independent predictor was determined according to the ? coefficient of multivariate logistic regression analysis and a clinical prediction model was established.The cutoff value and AUC of the predictive scoring model were determined by the ROC curve,and the sensitivity,specificity,PPV,and NPV were calculated.Results: In the tumor size <2 cm group,the type III procollagen(PC III)and hyaluronic acid(HA)had differences between NCR and CR(P=0.019 and P=0.080),the multivariate logistic regression analysis showed that neither PC III nor HA were independent predictors.In the tumor size between 2 and 5 cm group,the tumor size,irregular margins,arterial peritumoral enhancement,rim enhancement,satellite nodules and intratumoral artery had differences between NCR and CR(P=0.079,P<0.001,P=0.041,P=0.013,P=0.031 and P=0.034),and only an irregular margin was a significant independent predictor of early NCR(OR=5.324;95%CI: 2.018-14.045;P=0.001).In the tumor size >5 cm group,the irregular margin,arterial peritumoral enhancement,satellite nodules,PV/HV invasion,intratumoral artery,radiological capsule,minimum distance,and abnormal AFP values had differences between NCR and CR(P<0.001,P<0.001,P=0.089,P=0.005,P=0.009,P=0.074,P=0.084 and P=0.020),and the irregular margin(OR=13.753;95%CI: 1.522-124.267;P=0.020),arterial peritumoral enhancement(OR=6.241;95%CI:1.304-29.864;P=0.022),and abnormal alpha-fetoprotein(AFP)(OR=4.838;95%CI: 1.062-22.028;P=0.042)values were significant independent predictors of early NCR.The prediction model indicated that arterial peritumoral enhancement combined with irregular margins,abnormal AFP values combined with arterial peritumoral enhancement,and irregular margins were high-risk factors for NCR(cutoff=16.5),and the prediction model had good diagnostic performance(AUC=0.844),the sensitivity,specificity,PPV and NPV of the prediction model were 82.2%,73.7%,78.7% and 77.8%,respectively.Conclusion: Irregular margins of 2-5-cm tumors and irregular margins,arterial peritumoral enhancement,and abnormal AFP of tumors >5cm can be applied to predict the early response of HCC to TACE/HIFU treatment.Preoperative MRI features and laboratory indicators can be used to predict early responses to HCC after TACE/HIFU treatment and to guide therapeutic strategies and improve patient prognosis.