Gadoxetic acid uptake as a molecular imaging biomarker for sorafenib resistance in patients with hepatocellular carcinoma: a post hoc analysis of the SORAMIC trial

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Oecal O., Roessler D., Gasbarrini A., Berg T., Kluempen H., Bargellini I., ...More

JOURNAL OF CANCER RESEARCH AND CLINICAL ONCOLOGY, vol.148, no.9, pp.2487-2496, 2022 (SCI-Expanded) identifier identifier identifier

  • Publication Type: Article / Article
  • Volume: 148 Issue: 9
  • Publication Date: 2022
  • Doi Number: 10.1007/s00432-021-03803-3
  • Journal Name: JOURNAL OF CANCER RESEARCH AND CLINICAL ONCOLOGY
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus, Academic Search Premier, BIOSIS, CAB Abstracts, EMBASE, MEDLINE, Veterinary Science Database
  • Page Numbers: pp.2487-2496
  • Keywords: Hepatocellular carcinoma, Sorafenib, Radioembolization, Gadoxetic acid, WNT, ss-Catenin, CATENIN SIGNALING PATHWAY, DOUBLE-BLIND, MULTICENTER, ATEZOLIZUMAB, BEVACIZUMAB, MUTATION, THERAPY, PLACEBO
  • Hacettepe University Affiliated: Yes

Abstract

Purpose Gadoxetic acid uptake on hepatobiliary phase MRI has been shown to correlate with ss-catenin mutation in patients with HCC, which is associated with resistance to certain therapies. This study aimed to evaluate the prognostic value of gadoxetic acid uptake on hepatobiliary phase MRI in patients with advanced HCC receiving sorafenib. Methods 312 patients with available baseline hepatobiliary phase MRI images received sorafenib alone or following selective internal radiation therapy (SIRT) within SORAMIC trial. The signal intensity of index tumor and normal liver parenchyma were measured on the native and hepatobiliary phase MRI images, and relative tumor enhancement higher than relative liver enhancement were accepted as high gadoxetic acid uptake, and its prognostic value was assessed using univariate and multivariate Cox proportional hazard models. Results The median OS of the study population was 13.4 (11.8-14.5) months. High gadoxetic acid uptake was seen in 51 (16.3%) patients, and none of the baseline characteristics was associated with high uptake. In univariate analysis, high gadoxetic acid uptake was significantly associated with shorter overall survival (10.7 vs. 14.0 months, p = 0.005). Multivariate analysis confirmed independent prognostic value of high gadoxetic acid uptake (HR, 1.7 [1.21-2.3], p = 0.002), as well as Child-Pugh class (p = 0.033), tumor diameter (p = 0.002), and ALBI grade (p = 0.015). Conclusion In advanced HCC patients receiving sorafenib (alone or combined with SIRT), high gadoxetic acid uptake of the tumor on pretreatment MRI, a surrogate of ss-catenin mutation, correlates with shorter survival. Gadoxetic acid uptake status might serve in treatment decision-making process.