Decrease in Tumor Enhancement on Contrast-Enhanced CT is Associated with Improved Survival in Patients with Hepatocellular Carcinoma Treated with Sorafenib.

Background: This study investigates whether changes in arterial enhancement of hepatocellular carcinoma (HCC) on contrast-enhanced CT in patients treated with Sorafenib predicts overall survival.Methods: Thirty-seven HCC patients treated with Sorafenib were identified retrospectively. Up to two target liver lesions were measured on baseline and follow-up contrast-enhanced CT scans. Patients were stratified by whether arterial enhancement decreased by at least 15% and hazard ratio was calculated for all-cause mortality. Patients were then classified as progressive disease, stable disease or partial response using both the modified Response Evaluation Criteria in Solid Tumors (mRECIST) criteria and a novel system of enhancement-based response criteria we modeled on mRECIST, but substituting change in arterial enhancement for longest enhancing diameter as the primary measure of tumor response. This response stratification was assessed using survival analysis.Results: Patients with a 15% decrease in arterial enhancement on follow-up contrast-enhanced CT had median overall survival of 1022 days versus 189 days in those without; this corresponded to a significant decrease in risk of all-cause mortality (hazard ratio 0.34; P = 0.04). Response groups created using the enhancement-based criteria showed significant differences in overall survival (P < 0.001) and all response groups were significantly separated from each other on a pair-wise basis.Conclusions: Decrease in arterial tumor enhancement on follow-up contrast-enhanced CT by at least 15% was associated with improved overall survival in this small sample of HCC patients treated with Sorafenib and shows promise as a possible clinical measure of tumor response in this population.