Research ArticleDynamic contrast-enhanced magnetic resonance imaging biomarkers predict survival and response in hepatocellular carcinoma patients treated with sorafenib and metronomic tegafur/uracil

Background & AimsSorafenib plus metronomic tegafur/uracil therapy can induce tumor stabilization in advanced hepatocellular carcinoma (HCC) patients. This study evaluated the correlation of vascular response measured by dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and the clinical outcome.MethodsDCE-MRI was performed in advanced HCC patients treated with sorafenib (800 mg/d) plus tegafur/uracil (250 mg/m2/d based on tegafur) at baseline and after 14 days of treatment. An operator-defined region of interest was placed in the most strongly enhanced area of the tumor to measure the pharmacokinetic parameter Ktrans. Changes in Ktrans after treatment were correlated with the best tumor response and survival.ResultsThirty-one patients were evaluable. There were one partial response (PR), 18 stable disease (SD), and 12 progressive disease (PD) according to the Response Evaluation Criteria in Solid Tumors (RECIST). Baseline Ktrans was higher in patients with PR or SD (median 1215.2 × 10−3/min, range 582.5-4555.3 × 10−3/min) than patients with PD (median 702.0 × 10−3/min, range 375.2-1938.0 × 10−3/min, p = 0.008). After 14 days of study treatment, the median Ktrans change was −47.1% (range −87.0 to −18.0%) in patients with PR or SD, and 9.6% (range −44.8 to +81%) in those with PD (p <0.001). A vascular response, defined by a 40% or greater decrease in Ktrans after 14 days of study treatment, correlated with longer progression-free survival (median 29.1 vs. 8.7 weeks, p = 0.033) and overall survival (median 53.0 vs. 14.9 weeks, p = 0.016). Percentage of Ktrans change after treatment is an independent predictor of tumor response, progression-free survival, and overall survival.ConclusionsKtrans measured by DCE-MRI correlated well with tumor response and survival in HCC patients who received sorafenib plus metronomic tegafur/uracil therapy.