title: Radiographic response to locoregional therapy in hepatocellular carcinoma predicts patient survival times.
abstract: OBJECTIVE
  It is not clear whether survival times of patients with hepatocellular carcinoma (HCC) are associated with their response to therapy. We analyzed the association between tumor response and survival times of patients with HCC who were treated with locoregional therapies (LRTs) (chemoembolization and radioembolization).
  
  
  METHODS
  Patients received LRTs over a 9-year period (n = 463). Patients with metastases, portal venous thrombosis, or who had received transplants were excluded; 159 patients with Child-Pugh B7 or lower were analyzed. Response (based on European Association for the Study of the Liver [EASL] and World Health Organization [WHO] criteria) was associated with survival times using the landmark, risk-of-death, and Mantel-Byar methodologies. In a subanalysis, survival times of responders were compared with those of patients with stable disease and progressive disease.
  
  
  RESULTS
  Based on 6-month data, in landmark analysis, responders survived longer than nonresponders (based on EASL but not WHO criteria: P = .002 and .0694). The risk of death was also lower for responders (based on EASL but not WHO criteria: P = .0463 and .707). Landmark analysis of 12-month data showed that responders survived longer than nonresponders (P < .0001 and .004, based on EASL and WHO criteria, respectively). The risk of death was lower for responders (P = .0132 and .010, based on EASL and WHO criteria, respectively). By the Mantel-Byar method, responders had longer survival than nonresponders, based on EASL criteria (P < .0001; P = .596 with WHO criteria). In the subanalysis, responders lived longer than patients with stable disease or progressive disease.
  
  
  CONCLUSIONS
  Radiographic response to LRTs predicts survival time. EASL criteria for response more consistently predicted survival times than WHO criteria. The goal of LRT should be to achieve a radiologic response, rather than to stabilize disease.
authors.affiliation: Department of Radiology, Section of Interventional Radiology, Northwestern University, Robert H. Lurie Comprehensive Cancer Center, Chicago, Illinois 60611, USA.
authors.forename: Khairuddin
authors.initials: K
authors.lastname: Memon
authors.forename: Laura
authors.initials: L
authors.lastname: Kulik
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Lewandowski
authors.forename: Edward
authors.initials: E
authors.lastname: Wang
authors.forename: Ahsun
authors.initials: A
authors.lastname: Riaz
authors.forename: Robert K
authors.initials: RK
authors.lastname: Ryu
authors.forename: Kent T
authors.initials: KT
authors.lastname: Sato
authors.forename: Karen
authors.initials: K
authors.lastname: Marshall
authors.forename: Ramona
authors.initials: R
authors.lastname: Gupta
authors.forename: Paul
authors.initials: P
authors.lastname: Nikolaidis
authors.forename: Frank H
authors.initials: FH
authors.lastname: Miller
authors.forename: Vahid
authors.initials: V
authors.lastname: Yaghmai
authors.forename: Seanthan
authors.initials: S
authors.lastname: Senthilnathan
authors.forename: Talia
authors.initials: T
authors.lastname: Baker
authors.forename: Vanessa L
authors.initials: VL
authors.lastname: Gates
authors.forename: Michael
authors.initials: M
authors.lastname: Abecassis
authors.forename: Al B
authors.initials: AB
authors.lastname: Benson
authors.forename: Mary F
authors.initials: MF
authors.lastname: Mulcahy
authors.forename: Reed A
authors.initials: RA
authors.lastname: Omary
authors.forename: Riad
authors.initials: R
authors.lastname: Salem
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging / Q000401:mortality* / Q000473:pathology / Q000532:radiotherapy / Q000628:therapy*; D016461:Chemoembolization, Therapeutic; D003287:Contrast Media; D018450:Disease Progression; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality* / Q000473:pathology / Q000532:radiotherapy / Q000628:therapy*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media