# Dual-energy CT biomarkers for predicting the efficacy of TACE combined with lenvatinib and immune checkpoint inhibitors in unresectable HCC

## TL;DR

A new CT-based method predicts treatment response in unresectable liver cancer patients receiving a combination of TACE, lenvatinib, and immune checkpoint inhibitors.

## Contribution

A low-dose dual-energy and perfusion CT-based nomogram is developed to predict treatment efficacy in unresectable hepatocellular carcinoma.

## Key findings

- Normalized iodine concentration in the arterial phase (NIC-AP) was the best predictor of treatment response.
- A nomogram incorporating NIC-AP, permeability surface area product (PS), and tumor size achieved high predictive accuracy (AUROC = 0.913).
- The study used low-dose CT with a mean radiation dose of 19.02 mSv.

## Abstract

To develop a nomogram based on low-dose one-stop dual-energy and perfusion computed tomography (LD-DE&PCT) for predicting the efficacy of transcatheter arterial chemoembolization (TACE) combined with lenvatinib and immune checkpoint inhibitors (TACE-LEN-ICIs) in unresectable hepatocellular carcinoma (uHCC) patients.

This prospective, multicenter study included uHCC patients who underwent LD-DE&PCT scanning. The relationships between quantitative LD-DE&PCT-derived parameters and the efficacy of TACE-LEN-ICIs were analyzed using logistic regression analysis. A nomogram incorporating the independent predictors was constructed, and its predictive performance was evaluated by the area under the receiver operating characteristic curve (AUROC).

A total of 125 lesions from 71 uHCC patients were enrolled, with 71 lesions (56.8%) classified as the objective response (ObR) group and 54 lesions (43.2%) as the non-response (NR) group. Univariate analysis revealed significant differences in tumor size, corona enhancement, tumor location, iodine concentration in the arterial phase (IC-AP), normalized iodine concentration in the arterial phase (NIC-AP), effective atomic number in the arterial phase (Zeff-AP), slope of spectral HU curve in the arterial phase (λHU-AP), and permeability surface area product (PS) between ObR and NR groups. Among these, NIC-AP exhibited the highest predictive value (AUROC = 0.770; 95% confidence interval [CI]: 0.682‒0.858). Multivariate analysis identified tumor size, NIC-AP, and PS as independent predictors. The nomogram showed excellent performance (AUROC  = 0.913; 95% CI: 0.858–0.968). The total radiation dose was 19.02 ± 5.39 mSv.

The LD-DE&PCT-based nomogram can accurately predict the response to TACE-LEN-ICIs in uHCC patients.

Low-dose one-stop dual-energy and perfusion CT provides a noninvasive method to predict response to TACE combined with lenvatinib and immune checkpoint inhibitors in unresectable HCC.

Predicting response to TACE-LEN-ICIs in uHCC helps treatment decision-making.NIC-AP and PS from LD-DE&PCT, and tumor size were independent predictive biomarkers.NIC-AP was the best parameter for predicting response to TACE-LEN-ICIs in uHCC.

Predicting response to TACE-LEN-ICIs in uHCC helps treatment decision-making.

NIC-AP and PS from LD-DE&PCT, and tumor size were independent predictive biomarkers.

NIC-AP was the best parameter for predicting response to TACE-LEN-ICIs in uHCC.