Abstract：
OBJECTIVE: Gadoxetic acid uptake on hepatobiliary phase MRI has been shown to correlate with ß-catenin mutation in patients with HCC, which is associated with resistance to certain therapies. This study aimed to evaluate the prognostic value of gadoxetic acid uptake on hepatobiliary phase MRI in patients with advanced HCC receiving sorafenib.
METHODS: 312 patients with available baseline hepatobiliary phase MRI images received sorafenib alone or following selective internal radiation therapy (SIRT) within SORAMIC trial. The signal intensity of index tumor and normal liver parenchyma were measured on the native and hepatobiliary phase MRI images, and relative tumor enhancement higher than relative liver enhancement were accepted as high gadoxetic acid uptake, and its prognostic value was assessed using univariate and multivariate Cox proportional hazard models.
RESULTS: The median OS of the study population was 13.4 (11.8-14.5) months. High gadoxetic acid uptake was seen in 51 (16.3%) patients, and none of the baseline characteristics was associated with high uptake. In univariate analysis, high gadoxetic acid uptake was significantly associated with shorter overall survival (10.7 vs. 14.0 months, p = 0.005). Multivariate analysis confirmed independent prognostic value of high gadoxetic acid uptake (HR, 1.7 [1.21-2.3], p = 0.002), as well as Child-Pugh class (p = 0.033), tumor diameter (p = 0.002), and ALBI grade (p = 0.015).
CONCLUSIONS: In advanced HCC patients receiving sorafenib (alone or combined with SIRT), high gadoxetic acid uptake of the tumor on pretreatment MRI, a surrogate of ß-catenin mutation, correlates with shorter survival. Gadoxetic acid uptake status might serve in treatment decision-making process.
METHODS: 312 patients with available baseline hepatobiliary phase MRI images received sorafenib alone or following selective internal radiation therapy (SIRT) within SORAMIC trial. The signal intensity of index tumor and normal liver parenchyma were measured on the native and hepatobiliary phase MRI images, and relative tumor enhancement higher than relative liver enhancement were accepted as high gadoxetic acid uptake, and its prognostic value was assessed using univariate and multivariate Cox proportional hazard models.
RESULTS: The median OS of the study population was 13.4 (11.8-14.5) months. High gadoxetic acid uptake was seen in 51 (16.3%) patients, and none of the baseline characteristics was associated with high uptake. In univariate analysis, high gadoxetic acid uptake was significantly associated with shorter overall survival (10.7 vs. 14.0 months, p = 0.005). Multivariate analysis confirmed independent prognostic value of high gadoxetic acid uptake (HR, 1.7 [1.21-2.3], p = 0.002), as well as Child-Pugh class (p = 0.033), tumor diameter (p = 0.002), and ALBI grade (p = 0.015).
CONCLUSIONS: In advanced HCC patients receiving sorafenib (alone or combined with SIRT), high gadoxetic acid uptake of the tumor on pretreatment MRI, a surrogate of ß-catenin mutation, correlates with shorter survival. Gadoxetic acid uptake status might serve in treatment decision-making process.
摘要：
目的：肝癌患者肝胆活期MRI对胆酸的摄取与β-catenin突变相关，这与对某些疗法的抵抗有关。本研究旨在评估接受索拉非尼治疗的晚期HCC患者肝胆阶段MRI中gad酸摄取的预后价值。
方法：312例具有基线肝胆期MRI图像的患者在SORAMIC试验中接受了索拉非尼单独或选择性内放疗（SIRT）。在自然和肝胆相MRI图像上测量指标肿瘤和正常肝实质的信号强度，并且相对肿瘤增强高于相对肝脏增强被认为是高的gadoxetic酸摄取，并使用单变量和多变量Cox比例风险模型评估其预后价值。
结果：研究人群的中位OS为13.4(11.8-14.5)个月。51例（16.3％）患者高摄取gadoxetic酸，基线特征均不与高摄取相关。在单变量分析中，高氧化乙酸摄取与较短的总生存期显著相关(10.7vs.14.0个月，p=0.005)。多因素分析证实了高gadoxetic酸摄取的独立预后价值(HR，1.7[1.21-2.3],p=0.002),以及Child-Pugh班（p=0.033），肿瘤直径（p=0.002），和ALBI等级（p=0.015）。
结论：在接受索拉非尼（单独或联合SIRT）的晚期HCC患者中，预处理MRI对肿瘤的高氧化乙酸摄取，β-catenin突变的替代，与较短的生存有关。羟乙酸的摄取状态可能在治疗决策过程中起作用。
方法：312例具有基线肝胆期MRI图像的患者在SORAMIC试验中接受了索拉非尼单独或选择性内放疗（SIRT）。在自然和肝胆相MRI图像上测量指标肿瘤和正常肝实质的信号强度，并且相对肿瘤增强高于相对肝脏增强被认为是高的gadoxetic酸摄取，并使用单变量和多变量Cox比例风险模型评估其预后价值。
结果：研究人群的中位OS为13.4(11.8-14.5)个月。51例（16.3％）患者高摄取gadoxetic酸，基线特征均不与高摄取相关。在单变量分析中，高氧化乙酸摄取与较短的总生存期显著相关(10.7vs.14.0个月，p=0.005)。多因素分析证实了高gadoxetic酸摄取的独立预后价值(HR，1.7[1.21-2.3],p=0.002),以及Child-Pugh班（p=0.033），肿瘤直径（p=0.002），和ALBI等级（p=0.015）。
结论：在接受索拉非尼（单独或联合SIRT）的晚期HCC患者中，预处理MRI对肿瘤的高氧化乙酸摄取，β-catenin突变的替代，与较短的生存有关。羟乙酸的摄取状态可能在治疗决策过程中起作用。
