title: Evaluation of CT vascularization patterns for survival prognosis in patients with hepatocellular carcinoma treated by conventional TACE.
abstract: OBJECTIVE
  Transarterial chemoembolization (TACE) is an established treatment for intermediate stage hepatocellular carcinoma (HCC). The aim of this retrospective study was to evaluate the power of lesion vascularization criteria based on computed tomography for prognosis of overall survival before initiation of treatment.
  
  
  METHODS
  A total of 59 patients with intermediate stage HCC treated with TACE as first-line treatment were retrospectively evaluated. TACE procedures were performed using doxorubicin, cisplatin, and lipiodol. Response evaluation criteria in solid tumors version 1.1 (RECIST 1.1) were used to determine the initial tumor response. Four vascularization patterns (VP) of the largest target lesion (homogeneous vascularization [VP1], homogeneous vascularization with additional arterial hypervascularization [VP2], heterogeneous vascularization with [VP3] and without zones of hypervascularization [VP4]) were assessed prior to the first TACE and correlated to survival.
  
  
  RESULTS
  Kaplan-Meier analysis yielded a median overall survival of 608 days (standard error [SE], 120.5 days). Survival analysis showed significant differences depending on the vascularization patterns (P = 0.012; hazard ratio, 0.327): patients with homogeneously vascularized lesions (VP1, VP2) had a median overall survival of 1091 days (SE, 235.5 days). Patients with heterogeneous vascularization of the lesion (VP3 and VP4) showed a median overall survival of 508 days (SE, 113.9 days).
  
  
  CONCLUSIONS
  The vascularization pattern of the largest HCC lesion is helpful for survival prognosis under TACE treatment and therefore has the potential to be used as an additional parameter for treatment stratification.
authors.affiliation: Institutes of Diagnostic and Interventional Radiology, The Hannover Medical School, Hannover, Germany. rodt.thomas@mh-hannover.de.
authors.forename: Davut B
authors.initials: DB
authors.lastname: Hasdemir
authors.forename: Lukas Aguirre
authors.initials: LA
authors.lastname: Dávila
authors.forename: Nora
authors.initials: N
authors.lastname: Schweitzer
authors.forename: Bernhard C
authors.initials: BC
authors.lastname: Meyer
authors.forename: Armin
authors.initials: A
authors.lastname: Koch
authors.forename: Arndt
authors.initials: A
authors.lastname: Vogel
authors.forename: Frank
authors.initials: F
authors.lastname: Wacker
authors.forename: Thomas
authors.initials: T
authors.lastname: Rodt
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D006528:Carcinoma, Hepatocellular / Q000098:blood supply / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D016461:Chemoembolization, Therapeutic / Q000379:methods*; D002945:Cisplatin / Q000008:administration & dosage / Q000627:therapeutic use; D004317:Doxorubicin / Q000008:administration & dosage / Q000627:therapeutic use; D004998:Ethiodized Oil / Q000008:administration & dosage; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000098:blood supply / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D008297:Male; D009389:Neovascularization, Pathologic / Q000000981:diagnostic imaging*; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D004998:Ethiodized Oil; D004317:Doxorubicin; D002945:Cisplatin