AI-assisted ascites volumetry for prognostic stratification in HCC treated with Atezolizumab/Bevacizumab.

IF 4.8 2区医学 Q2 ONCOLOGY

Cancer Imaging Pub Date : 2026-08-11 DOI:10.1186/s40644-026-01105-w

Maximilian Moos, Daniel Bender, Friedrich Foerster, Lucas Wiesmann, Arndt Weinmann, Roman Kloeckner, Constantin Scholz, André Euler, Aline Mähringer-Kunz, Tobias Bäuerle, Fabian Stoehr, Felix Hahn, Lukas Müller

{"title":"AI-assisted ascites volumetry for prognostic stratification in HCC treated with Atezolizumab/Bevacizumab.","authors":"Maximilian Moos, Daniel Bender, Friedrich Foerster, Lucas Wiesmann, Arndt Weinmann, Roman Kloeckner, Constantin Scholz, André Euler, Aline Mähringer-Kunz, Tobias Bäuerle, Fabian Stoehr, Felix Hahn, Lukas Müller","doi":"10.1186/s40644-026-01105-w","DOIUrl":null,"url":null,"abstract":"Purpose: Portal hypertension-related parameters are known to have important prognostic implications in patients with hepatocellular carcinoma (HCC). Ascites has consistently been associated with impaired outcomes. However, the prognostic relevance of quantified ascites volume in patients undergoing Atezolizumab/Bevacizumab remains unclear.Methods: 90 patients with HCC treated with Atezolizumab/Bevacizumab between 2020 and 2024 were retrospectively included. Ascites was assessed on baseline contrast-enhanced CT imaging using AI-based pre-segmentation followed by manual correction to quantify ascites volume. Overall survival (OS) was analyzed using Kaplan-Meier analysis and Cox regression. Ascites volume was analyzed both as a continuous variable and using predefined volumetric cutoffs (< 613.5 mL and ≥ 613.5 mL).Results: Ascites was present in 39% of patients, with a median ascites volume of 344 mL (IQR 29-929). When analyzed as a continuous variable, ascites volume was significantly associated with impaired OS in univariate analysis (Hazard Ratio (HR) 2.88, p < 0.001) but not after multivariate adjustment (p = 0.214). Stratification by ascites volume revealed a stepwise reduction in OS, with patients without ascites showing the best survival, followed by patients with low-volume ascites (< 613.5 ml), and patients with high-volume ascites (≥ 613.5 ml) demonstrating the poorest outcomes (log-rank p < 0.001). In multivariate analysis, high-volume ascites remained independently associated with impaired OS (HR 4.01, p < 0.001), whereas low-volume ascites did not.Conclusion: Ascites volume showed a threshold-dependent prognostic effect in patients with HCC treated with Atezolizumab/Bevacizumab. Volumetric staging identifies high-volume ascites as an independent marker of poor outcome and may provide more clinically relevant risk stratification than binary ascites assessment.Clinical trial number: Not applicable.","PeriodicalId":9548,"journal":{"name":"Cancer Imaging","volume":"26 1","pages":""},"PeriodicalIF":4.8000,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13471367/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Cancer Imaging","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1186/s40644-026-01105-w","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"ONCOLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Purpose: Portal hypertension-related parameters are known to have important prognostic implications in patients with hepatocellular carcinoma (HCC). Ascites has consistently been associated with impaired outcomes. However, the prognostic relevance of quantified ascites volume in patients undergoing Atezolizumab/Bevacizumab remains unclear.

Methods: 90 patients with HCC treated with Atezolizumab/Bevacizumab between 2020 and 2024 were retrospectively included. Ascites was assessed on baseline contrast-enhanced CT imaging using AI-based pre-segmentation followed by manual correction to quantify ascites volume. Overall survival (OS) was analyzed using Kaplan-Meier analysis and Cox regression. Ascites volume was analyzed both as a continuous variable and using predefined volumetric cutoffs (< 613.5 mL and ≥ 613.5 mL).

Results: Ascites was present in 39% of patients, with a median ascites volume of 344 mL (IQR 29-929). When analyzed as a continuous variable, ascites volume was significantly associated with impaired OS in univariate analysis (Hazard Ratio (HR) 2.88, p < 0.001) but not after multivariate adjustment (p = 0.214). Stratification by ascites volume revealed a stepwise reduction in OS, with patients without ascites showing the best survival, followed by patients with low-volume ascites (< 613.5 ml), and patients with high-volume ascites (≥ 613.5 ml) demonstrating the poorest outcomes (log-rank p < 0.001). In multivariate analysis, high-volume ascites remained independently associated with impaired OS (HR 4.01, p < 0.001), whereas low-volume ascites did not.

Conclusion: Ascites volume showed a threshold-dependent prognostic effect in patients with HCC treated with Atezolizumab/Bevacizumab. Volumetric staging identifies high-volume ascites as an independent marker of poor outcome and may provide more clinically relevant risk stratification than binary ascites assessment.

Clinical trial number: Not applicable.

查看原文本刊更多论文

人工智能辅助腹水容量测定用于阿特唑单抗/贝伐单抗治疗HCC的预后分层。

目的：门脉高压相关参数对肝细胞癌（HCC）患者的预后有重要影响。腹水一直与预后受损有关。然而，量化腹水容量在接受Atezolizumab/Bevacizumab治疗的患者中的预后相关性仍不清楚。方法：回顾性分析2020年至2024年间使用Atezolizumab/Bevacizumab治疗的90例HCC患者。采用基于人工智能的预分割，然后人工校正，在基线对比增强CT成像上评估腹水，以量化腹水体积。采用Kaplan-Meier分析和Cox回归分析总生存期（OS）。腹水容量作为连续变量和使用预定义的容量截止值进行分析（结果：39%的患者存在腹水，中位腹水容量为344 mL (IQR 29-929)）。当作为一个连续变量进行分析时，在单变量分析中，腹水体积与OS受损显著相关（风险比（HR） 2.88, p）。结论：腹水体积在阿特唑单抗/贝伐单抗治疗的HCC患者中显示出阈值依赖的预后作用。容量分期将大容量腹水确定为预后不良的独立标志，可能比二元腹水评估提供更多临床相关的风险分层。临床试验号：不适用。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Cancer Imaging ONCOLOGY-RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

CiteScore

7.00

自引率

0.00%

发文量

审稿时长

>12 weeks

期刊介绍： Cancer Imaging is an open access, peer-reviewed journal publishing original articles, reviews and editorials written by expert international radiologists working in oncology. The journal encompasses CT, MR, PET, ultrasound, radionuclide and multimodal imaging in all kinds of malignant tumours, plus new developments, techniques and innovations. Topics of interest include: Breast Imaging Chest Complications of treatment Ear, Nose & Throat Gastrointestinal Hepatobiliary & Pancreatic Imaging biomarkers Interventional Lymphoma Measurement of tumour response Molecular functional imaging Musculoskeletal Neuro oncology Nuclear Medicine Paediatric.