Page 55 - 台灣肝癌醫學冬季會手冊-1222-V3_Neat

An increase in hepatic heterogeneity linked to better survival of

hepatocellular carcinoma after transarterial chemoembolization

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1
2*
Hsuan-Hwai Lin 1, 2* , Wei-Chou Chang , Yu-Lueng Shih , Tsai-Yuan Hsieh , Francis Yao , Benjamin Yeh
1
1 Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical
Center, Taipei, Taiwan; Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA;
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2
Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; Division of
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Gastroenterology, Department of Internal Medicine, University of California, San Francisco, CA
Abstract

Purpose: The aim of this study to define the role of heterogeneity of liver parenchymal enhancement on computed
tomography (CT) in the survival of patients with early and intermediate-stage hepatocellular carcinoma (HCC) after
transarterial chemoembolization (TACE).
Methods: We retrospectively reviewed the medical records of the patients who had early and intermediate-stage HCCs,
and undergone TACE as the initial HCC treatment modality. The heterogeneity of liver parenchymal enhancement was
estimated using standard deviation (SD) of the enhanced values of CT scan. SD >5.6 was heterogenous enhancement,

and SD ≦5.6 was homogeneous enhancement.

Results: 30 patients were heterogenous enhancement and 86 patients were homogeneous enhancement. The clinical
characteristics, liver function reserve, and severity of liver fibrosis of these two groups were not different, but the
Kaplan-Meier survival curve showed a longer survival in patients with heterogenous enhancement (Fig. 1, Log-rank test,
p = 0.001). 47 patients underwent liver transplants at the following years. The pathologic findings of liver explants
showed 16 (44.4%) patients with homogenous enhancement had micronodular cirrhosis, but 11 (100%) patients with

heterogenous enhancement had non-micronodular cirrhosis (p = 0.003). The patients with homogenous enhancement
tended to have higher alpha-fetoprotein (AFP) compared with others (128.7 vs. 34.2 ng/ml), but it did not reach statistical
significance (p = 0.086).
Conclusions: The early and intermediate-stage HCC patients who had undergone TACE as the initial treatment modality
with heterogeneity of liver parenchymal enhancement tended to have non-micronodular cirrhosis and associate a longer

survival.
Fig. 1 Comparison of the survival curve according to the heterogeneity of
liver parenchymal enhancement on CT scan (Log-rank test, p = 0.001). CT:
computed tomography; SD: standard deviation.