Prediction of therapeutic response of advanced hepatocellular carcinoma to combined targeted immunotherapy by MRI.

PURPOSE:To assess the value of pre-treatment MRI in predicting treatment response to combined targeted immunotherapy in advanced hepatocellular carcinoma (HCC). METHODS:Totally 35 HCC participants who underwent pre-treatment contrast-enhanced MRI and received combined tyrosine kinase inhibitor (TKI) and anti-PD-1 antibody treatment were enrolled. Univariable and multivariable logistic regression analyses were carried out for comparing clinical and MRI characteristics between patients with therapeutic response and those without. A predictive model based on MRI data and the corresponding nomogram were developed using data generated by multivariate analysis, and the diagnostic performance was evaluated. A cutoff for the combined index was measured by receiver operating characteristic curve analysis, and progression-free survival (PFS) rates were compared between cases with high and low combined index values. RESULTS:Fifteen (42.86%) cases achieved overall response during treatment. Multivariable analysis revealed that homogeneous signal (odds ratio [OR] = 13.51, P = 0.010) and no arterial peritumoral enhancement (APE; OR = 10.29, P = 0.024) independently predicted treatment response. The combined model including both significant MRI parameters showed a satisfactory predictive performance with the largest area under the curve of 0.837 (95%CI 0.673-0.939), and both sensitivity and specificity of 80.0%. HCCs with high-combined index had higher PFS rate compared with those showing a low value (P = 0.034). CONCLUSION:The combination of pre-treatment MRI features of homogeneous signal and no APE could be used for predicting treatment response to combined targeted immunotherapy in advanced HCC.