3D Quantitative tumour burden analysis in patients with hepatocellular carcinoma before TACE: comparing single-lesion vs. multi-lesion imaging biomarkers as predictors of patient survival

To compare the ability of single- vs. multi-lesion assessment on baseline MRI using 1D- and 3D-based measurements to predict overall survival (OS) in patients with hepatocellular carcinoma (HCC) before transarterial chemoembolization (TACE). This retrospective analysis included 122 patients. A quantitative 3D analysis was performed on baseline MRI to calculate enhancing tumour volume (ETV [cm3]) and enhancing tumour burden (ETB [%]) (ratio between ETV [cm3] and liver volume). Furthermore, enhancing and overall tumour diameters were measured. Patients were stratified into two groups using thresholds derived from the BCLC staging system. Statistical analysis included Kaplan–Meier plots, uni- and multivariate cox proportional hazard ratios (HR) and concordances. All methods achieved good separation of the survival curves (p < 0.05). Multivariate analysis showed an HR of 5.2 (95 % CI 3.1–8.8, p < 0.001) for ETV [cm3] and HR 6.6 (95 % CI 3.7–11.5, p < 0.001) for ETB [%] vs. HR 2.6 (95 % CI 1.2–5.6, p = 0.012) for overall diameter and HR 3.0 (95 % CI 1.5–6.3, p = 0.003) for enhancing diameter. Concordances were highest for ETB [%], with no added predictive power for multi-lesion assessment (difference between concordances not significant). 3D quantitative assessment is a stronger predictor of survival as compared to diameter-based measurements. Assessing multiple lesions provides no substantial improvement in predicting OS than evaluating the dominant lesion alone. • 3D quantitative tumour assessment on baseline MRI predicts survival in HCC patients. • 3D quantitative tumour assessment predicts survival better than any current radiological method. • Multiple lesion assessment provides no improvement than evaluating the dominant lesion alone. • Measuring enhancing tumour volume in proportion to liver volume reflects tumour burden.