1. Radiographic and α-fetoprotein response predict pathologic complete response to immunotherapy plus a TKI in hepatocellular carcinoma: a multicenter study.
- Author
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Huang, Cheng, Zhu, Xiao-Dong, Shen, Ying-Hao, Xu, Bin, Wu, Dong, Ji, Yuan, Chen, Ling-Li, Song, Tian-Qiang, Zhang, Wei, Zeng, Zhi-Ming, Huang, Hua-Sheng, Wang, Kui, Huang, Lan-Qing, Chen, Yong-Jun, Yang, Yu-Chen, Zhou, Le-Du, Long, Guo, Zhao, Hai-Tao, Wang, Yun-Chao, and Ge, Ning-Ling
- Subjects
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RECEIVER operating characteristic curves , *PROTEIN-tyrosine kinase inhibitors , *PATHOLOGIC complete response - Abstract
Background: Pathologic complete response (pCR) following preoperative systemic therapy is associated with improved outcomes after subsequent liver transplant/resection in hepatocellular carcinoma (HCC). However, the relationship between radiographic and histopathological response remains unclear. Methods: We retrospectively examined patients with initially unresectable HCC who received tyrosine kinase inhibitor (TKI) plus anti–programmed death 1 (PD-1) therapy before undergoing liver resection between March 2019 and September 2021 across 7 hospitals in China. Radiographic response was evaluated using mRECIST. A pCR was defined as no viable tumor cells in resected samples. Results: We included 35 eligible patients, of whom 15 (42.9%) achieved pCR after systemic therapy. After a median follow-up of 13.2 months, tumors recurred in 8 non-pCR and 1 pCR patient. Before resection, there were 6 complete responses, 24 partial responses, 4 stable disease cases, and 1 progressive disease case, per mRECIST. Predicting pCR by radiographic response yielded an area under the receiver operating characteristic curve (AUC) of 0.727 (95% CI: 0.558–0.902), with an optimal cutoff value of 80% reduction in the enhanced area in MRI (called major radiographic response), which had a 66.7% sensitivity, 85.0% specificity, and a 77.1% diagnostic accuracy. When radiographic response was combined with α-fetoprotein response, the AUC was 0.926 (95% CI: 0.785–0.999); the optimal cutoff value was 0.446, which had a 91.7% sensitivity, 84.6%, specificity, and an 88.0% diagnostic accuracy. Conclusions: In patients with unresectable HCC receiving combined TKI/anti–PD 1 therapy, major radiographic response alone or combined with α-fetoprotein response may predict pCR. [ABSTRACT FROM AUTHOR]
- Published
- 2023
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