Tumor Response Assessment in Hepatocellular Carcinoma
Summary
The assessment of tumour response in hepatocellular carcinoma (HCC) has evolved from simple uni-dimensional measurements to advanced multiparametric imaging and biomarker-driven criteria. Conventional response evaluation criteria in solid tumours (RECIST v1.1) rely on changes in lesion diameter, but may fail to capture intralesional necrosis or vascular changes induced by locoregional and systemic therapies. The modified RECIST (mRECIST) criteria address this limitation by measuring the viable, contrast-enhancing portion of the tumour during the arterial phase. European Association for the Study of the Liver (EASL) criteria and Choi criteria further incorporate changes in enhancement and density. Emerging approaches include volumetric and density-based measurements on computed tomography (CT), dynamic contrast-enhanced magnetic resonance imaging (MRI) metrics, perfusion imaging and automated segmentation algorithms. Objective response, defined by complete or partial response, has been validated as an independent predictor of overall survival and is used as an early surrogate endpoint in clinical trials. Additional metrics such as sustained response duration, early tumour shrinkage and perfusion parameters serve to refine prognostication and to guide treatment sequencing between locoregional interventions and systemic agents including tyrosine kinase inhibitors and immunotherapies. The global impact of accurate response assessment is particularly pronounced given the heterogeneous aetiology of HCC, regional variations in treatment access and the need for personalised therapeutic strategies.
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Tumor Response Assessment in Hepatocellular Carcinoma publication trend
The graph below shows the total number of articles in tumor response assessment in hepatocellular carcinoma across all publications each year (not limited to Nature Index journals).
Technical terms
RECIST v1.1: Standardised criteria that measure changes in longest tumour diameter to categorise response.
Modified RECIST (mRECIST): Criteria that assess only the viable, contrast-enhancing portion of HCC lesions on arterial-phase imaging.
Objective response: Sum of complete and partial responses indicating a measurable reduction in tumour burden.
Early tumour shrinkage (ETS): Percentage reduction in enhancing tumour size at an early imaging time point, often ≥20%.
Overall survival (OS): Time from treatment initiation until death from any cause, a key clinical endpoint.
Volume of enhancement of disease (VED): A parameter combining arterial enhancement coefficient with lesion volume on CT to predict treatment response.
Tumour necrosis: Non-viable tumour tissue often inferred from imaging as regions without contrast uptake.
References
- Tumor response evaluation criteria for HCC (hepatocellular carcinoma) treated using TACE (transcatheter arterial chemoembolization): RECIST (response evaluation criteria in solid tumors) version 1.1 and mRECIST (modified RECIST): JIVROSG-0602. Upsala Journal of Medical Sciences (2012).
- Association of Sustained Response Duration With Survival After Conventional Transarterial Chemoembolization in Patients With Hepatocellular Carcinoma. JAMA Network Open (2018).
- Overall survival and objective response in advanced unresectable hepatocellular carcinoma: A subanalysis of the REFLECT study. Journal of Hepatology (2022).
- Early tumor shrinkage and response assessment according to mRECIST predict overall survival in hepatocellular carcinoma patients under sorafenib. Cancer Imaging (2022).
- Assessment of tumor volume and density as a measure of the response of advanced hepatocellular carcinoma to sorafenib: Application of automated measurements on computed tomography scans. JGH Open (2019).
- CT volume of enhancement of disease (VED) can predict the early response to treatment and overall survival in patients with advanced HCC treated with sorafenib. European Radiology (2020).
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