Pretreatment apparent diffusion coefficient as a predictor of prognosis after combined treatment of TACE and radiofrequency ablation for solitary large hepatocellular carcinoma / 中华肝胆外科杂志

ABSTRACT

Objective:To study the predictive value of pretreatment apparent diffusion coefficient (ADC) on prognosis in patients with isolated large hepatocellular carcinoma(SLHCC) treated by combined transcatheter arterial chemoembolization (TACE) and radiofrequency ablation (RFA).Methods:A retrospective analysis was performed on 40 patients with SLHCC who were treated at the Department of Interventional Radiology, the First Medical Center of PLA General Hospital from December 2014 to July 2018, with combined TACE and RFA. There were 34 males and 6 females, with an average age of 55.9 years. All patients underwent enhanced abdominal MRI within 1 week before and 1 month after treatment. The receiver operating characteristic (ROC) curve was used to assess the predictive efficacy value of ADC. The survival curves were plotted by the Kaplan-Meier method and compared with the log-rank test. Univariate and multivariate prognostic analyses were performed using the Cox proportional hazard models.Results:After treatment, there were 18 patients with complete response and 12 with partial response. The objective response rate was 75.0% (30/40). The area under ROC curve of ADC in predicting the effectiveness of TACE combined with RFA (complete response + partial response) was 0.86 (95% CI 0.74-0.98). The optimal threshold was 1.32×10 -3 mm 2/s, the sensitivity was 0.63, and the specificity was 1.00. The progression-free survival rate and cumulative survival rate in the high ADC group (≥1.32×10 -3mm 2/s, n=19) were better than that in the low ADC group (<1.32×10 -3mm 2/s, n=21), with significant differences (both P<0.05). On multivariate analysis, ADC<1.32×10 -3mm 2/s ( HR=3.711, 95% CI 1.705-8.074; P<0.05) was an independent risk factor for progression-free survival, while ADC < 1.32×10 -3mm 2/s ( HR=3.518, 95% CI 1.016-12.185, P<0.05) was an independent risk factor for overall survival. Conclusion:Preoperative ADC was an independent risk factor for prognosis in patients with SLHCC undergoing TACE combined with RFA. It has value in prognostic prediction.