LI-RADS TRA v2024在TACE治疗的HCC中优于RECIST和mRECIST：基于存活性的生存预测
本研究纳入105例接受TACE的HCC患者，由四名放射科医师独立使用LI-RADS TRA v2024、RECIST和mRECIST评估反应。LI-RADS TRA可区分总生存（无反应者平均719.8天 vs 有反应者1002.1天，p=0.014，HR=1.63），而RECIST和mRECIST无显著分层；LI-RADS TRA对进展时间区分较弱（p=0.095）。联合定量强化-大小变化可增强生存预测（HR=1.91，p=0.026）。
要点
- LI-RADS TRA v2024可对TACE后HCC患者进行生存风险分层，优于RECIST和mRECIST。
- LI-RADS TRA对进展时间的预测能力有限，影像反应主要预测累积死亡率而非进展时机。
- 联合定量强化-大小变化可进一步改善LI-RADS TRA的生存预测性能。
局限性
- 样本量有限（105例）。
- 单中心研究设计。
- LI-RADS TRA对进展时间区分无统计学意义（p=0.095）。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
英文原文（摘要）· 点击展开
BACKGROUND: Despite robust response assessment validation of Liver Imaging Reporting and Data System Treatment Response Algorithm (LI-RADS TRA) version 2024, a critical evidence gap exists for its prognostic value in non-radiation hepatocellular carcinoma (HCC) therapies. Conventional response assessment criteria (RECIST, mRECIST) focus on morphologic changes, not tumor viability.
PURPOSE: To evaluate the prognostic implications of LI-RADS TRA v2024 versus RECIST and mRECIST for predicting overall survival and time to progression in HCC patients treated with trans-arterial chemoembolization (TACE), and to assess whether quantitative enhancement reduction augments prognostic stratification.
METHODS: A total of 105 HCC patients undergoing TACE with multi-phasic contrast-enhanced CT were included. Four board-certified radiologists independently assessed tumor response using LI-RADS TRA v2024, RECIST, and mRECIST criteria.
RESULTS: LI-RADS TRA demonstrated convergent prognostic discrimination for overall survival, with non-responders achieving mean survival of 719.8 days versus responders 1,002.1 days (p = 0.014; hazard ratio 1.63). In contrast, RECIST (p = 0.670, hazard ratio 0.72) and mRECIST (p = 0.457, hazard ratio 1.16) showed negligible stratification. Importantly, LI-RADS TRA exhibited weak discrimination for time to progression (p = 0.095). Incorporating quantitative enhancement-size change from pre-TACE to post-TACE (%) substantially enhanced LI-RADS TRA prognostic performance for survival (HR 1.91, p = 0.026), but not progression prediction.
CONCLUSION: LI-RADS TRA v2024 outperforms conventional size-based and enhancement-duration criteria for mortality risk stratification in TACE-treated HCC, reflecting mechanistic potential of viability-based assessment. However, imaging response predicts cumulative mortality, not progression timing. Integration of quantitative enhancement metrics refines risk stratification for surveillance planning.
引用
- Mohebbi A, Zare M, Mohammadi A, et al. LI-RADS TRA v2024 succeeds where RECIST and mRECIST fail: viability-based survival prediction in TACE-treated hepatocellular carcinoma. Abdom Radiol (NY). 2026. PMID: 42118269. doi:10.1007/s00261-026-05556-4
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。