Hepatocellular carcinoma treated with sorafenib: Arterial tumor perfusion in dynamic contrast-enhanced CT as early imaging biomarkers for survival

Objectives To investigate whether hepatic perfusion CT yields early imaging biomarkers predictive of the prognosis of hepatocellular carcinoma (HCC) patients treated with sorafenib. Methods We evaluated 36 HCC patients who underwent hepatic perfusion CT before- and one week after sorafenib therapy. We measured arterial and portal perfusion in the hepatic tumor and liver parenchyma [(AP)(PP)tumor], [(AP)(PP)liver]. The perfusion ratio was calculated by dividing the post- by the pre-sorafenib value. The effect of each value on the overall survival rate was analyzed with the Cox proportional hazards model; statistically significant parameters were subjected to receiver operating characteristic analysis based on median survival after sorafenib administration to determine the overall survival rate with the Kaplan-Meier method. Results Pre-APtumor was significantly associated with the overall survival rate (hazard ratio (HR) and 95% confidence interval (CI), 0.16 and 0.02-0.84, p = 0.03). The APtumor ratio tended to be associated with the overall survival rate (HR and 95% CI, 2.94 and 0.94-7.88, p = 0.06). The overall survival rate was higher in patients with pre-APtumor >71.7 mL/min/100 mL, and with APtumor ratio ≦ 1.1 (p < 0.01 and 0.03, respectively, in Kaplan-Meier method with log-rank). Conclusion Hepatic perfusion CT yields early imaging biomarkers for predicting overall survival in HCC patients treated with sorafenib.