Radiologic partial response poorly predicts pathologic complete response in hepatocellular carcinoma after conversion therapy

Table 1 Baseline characteristics of the study population, n (%)/median (interquartile range)

Characteristics1	Total (n = 66)
Age (years)	53 (47, 62)
Sex
Female	6 (9.09)
Male	60 (90.91)
HBV infection
Yes	58 (87.88)
No	8 (12.12)
MASLD
Yes	10 (15.15)
No	56 (84.85)
BCLC stage
B	23 (34.85)
C	43 (65.15)
Child-Pugh class
A	61 (92.42)
B	5 (7.58)
PVTT
Yes	16 (24.24)
No	50 (75.76)
Extrahepatic metastasis
Yes	22 (66.67)
No	44 (33.33)
Number of systemic therapy cycles	4 (3, 6)
Pre-treatment largest tumour diameter (cm), median (range)	8.6 (1.6, 18.6)
Post-treatment largest tumour diameter (cm)2, median (range)	6.1 (1.1, 15.4)
Baseline AFP level	280 (120.8, 4200)
Tumour response by mRECIST
PR	55 (83.33)
SD	11 (16.67)
Tumour response by RECIST 1.1
PR	37 (56.06)
SD	29 (43.94)
pCR
Yes	20 (30.30)
No	46 (69.70)
OS (months), median (95%CI)	Not reached
PFS (months), median (95%CI)	33.27 (19.3-40.63)

¹Continuous variables are expressed as mean ± SD when normally distributed and as median (interquartile range) when non-normally distributed. Categorical variables are expressed as n (%).

²Defined as the period after immunotherapy and locoregional treatment and before surgical resection.

HBV: Hepatitis B virus; MASLD: Metabolic dysfunction-associated steatotic liver disease; BCLC: Barcelona Clinic Liver Cancer; PVTT: Portal vein tumour thrombus; AFP: Alpha-fetoprotein; mRECIST: Modified Response Evaluation Criteria in Solid Tumours; RECIST 1.1: Response Evaluation Criteria in Solid Tumours version 1.1; PR: Partial response; SD: Stable disease; pCR: Pathologic complete response; OS: Overall survival; PFS: Progression-free survival; CI: Confidence interval.

Table 2 Association between radiologic response and pathologic complete response

Radiologic response	pCR	Non-pCR	Total
mRECIST
PR	20	35	55
SD	0	11	11
Total	20	46	66
RECIST 1.1
PR	12	25	37
SD	8	21	29
Total	20	46	66

pCR: Pathologic complete response; mRECIST: Modified Response Evaluation Criteria in Solid Tumours; PR: Partial response; SD: Stable disease; RECIST 1.1: Response Evaluation Criteria in Solid Tumours version 1.1.

Table 3 Diagnostic performance of modified Response Evaluation Criteria in Solid Tumours and Response Evaluation Criteria in Solid Tumours version 1.1 for predicting pathologic complete response

Metric	mRECIST	RECIST 1.1
Sensitivity (%)	100.0	60.0
Specificity (%)	23.9	45.7
Positive predictive value (%)	36.4	32.4
Negative predictive value (%)	100.0	72.4
Accuracy (%)	47.0	50.0
Cohen’s kappa coefficient (κ)	0.160	0.046

mRECIST: Modified Response Evaluation Criteria in Solid Tumours; RECIST 1.1: Response Evaluation Criteria in Solid Tumours version 1.1.

Table 4 Concordance between radiologic response and pathological response

Classification	mRECIST	RECIST 1.1
PR + pCR (true positive)	20	12
PR + non-pCR (false positive)	35	25
SD + pCR (false negative)	0	8
SD + non-pCR (true negative)	11	21

mRECIST: Modified Response Evaluation Criteria in Solid Tumours; RECIST 1.1: Response Evaluation Criteria in Solid Tumours version 1.1; PR: Partial response; pCR: Pathologic complete response; SD: Stable disease.