Preoperative MRI features for predicting response to postoperative adjuvant anti-PD-1 therapy in hepatocellular carcinoma

RATIONALE AND OBJECTIVES: Biomarkers for predicting survival benefit of postoperative adjuvant anti-PD-1 therapy (PA-PD-1) in hepatocellular carcinoma (HCC) are scare and lack of clinical evidence currently. This study aimed to identify the value of preoperative MRI features for predicting response to PA-PD-1 in HCC. MATERIALS AND METHODS: Between January 2020 and June 2023, consecutive eligible patients after curative hepatectomy were retrospectively enrolled and prospectively followed-up. MRI features were independently reviewed by two radiologists. Overall survival (OS) and recurrence-free survival (RFS) were compared between subgroups. Independent prognostic risk factors for OS and RFS were confirmed by Cox regression analysis. RESULTS: Fifty-eight patients (54 years ± 12; 56 men) with PA-PD-1 and 110 patients (52 years ± 12; 101 men) without PA-PD-1 were analyzed after propensity-score matching. Patients with PA-PD-1 had significantly longer RFS than those without PA-PD-1 (29.50 versus 10.97 months, p = .005). Absence of hypointense halos (HR = 1.635; 95% CI: 1.066-2.510; p = .024) and irregular rim-like hyper enhancement (HR = 0.566; 95% CI: 0.379-0.845; p = .005) were identified as independent predictors for RFS. Subgroup analysis indicated that patients with absence of hypointense halos and irregular rim-like hyper enhancement achieved significantly longer RFS after PA-PD-1 compared with those without PA-PD-1. CONCLUSION: Preoperative MRI features of absence of hypointense halos and irregular rim-like hyper enhancement were significantly associated with recurrence and potential predictors for response to PA-PD-1 in HCC.