Can ADC changes help mRECIST or LI-RADS treatment response algorithm better diagnose pathological response of HCC after preoperative radiotherapy? Secondary analysis of a prospective phase 2 trial
Abstract
To explore the role of apparent diffusion coefficient (ADC) changes in predicting pathological response to preoperative radiotherapy (RT) in hepatocellular carcinoma (HCC) compared to existing evaluation criteria, using histopathology as the reference standard. Building on the prospective clinical trial, we included 35 patients with 38 HCCs who underwent preoperative RT followed by hepatectomy between December 2014 and January 2019. Pre- and post-RT ADC parameters (ADCroi and ADCslice measured from representative areas and histogram parameters derived from whole-tumor volume) were compared, and the percentage change of parameters (Δ-parameters%) was calculated to correlate with major pathological response (MPR). The modified Response Evaluation Criteria in Solid Tumors (mRECIST) and Liver Imaging Reporting and Data System Treatment Response (LR-TR) categories were evaluated. ROC analysis was performed to assess discrimination performance. ADC values, interquartile range, range, variance, mean absolute deviation, robust mean absolute deviation, and root mean squared increased; energy and total energy decreased; and skewness developed into negative skewness after RT. Higher Δ-ADCroi%, Δ-ADCslice%, Δ-ADCmean%, and Δ-ADCmedian% and lower Δ-energy% and Δ-total energy% were associated with MPR. LR-ADCslice showed the best performance, with significantly higher AUC than mRECIST/LR-TR, Δ-ADCmean%, and Δ-ADCmedian% (0.917 vs 0.708, 0.732, and 0.705, respectively; p = 0.005, 0.029,…
How strong is the evidence?
Evidence Hub reads this as a secondary / pooled analysis, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 35 participants or records.
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