Local recurrence following complete radiologic response in patients treated with transarterial chemoembolization for hepatocellular carcinoma - 24/02/22
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Highlights |
• | A significant proportion of patients with hepatocellular carcinoma who achieve complete radiologic response following transarterial chemoembolization will have local recurrence. |
• | Variables such as liver function prior to transarterial chemoembolization and cause of underlying cirrhosis may predict local recurrence rates following complete response. |
• | This study suggests that transarterial chemoembolization should be considered palliative and emphasizes the importance of long term follow up by interventional radiologists after treatment. |
Abstract |
Purpose |
The purpose of this study was to determine the local progression rate and identify factors that may predict local progression, in patients who achieve a complete response (CR) radiologically after undergoing transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC).
Materials and methods |
One-hundred-forty-seven patients, who achieved CR of 224 HCCs after TACE, were retrospectively reviewed. There were 109 men and 38 women with a mean age of 61.6 ± 6.8 (SD) years (range: 45.4–86.9 years). Logistic mixed-effects and Cox regression models were used to evaluate associations between clinical factors and local progression.
Results |
A total of 75 patients (75/147; 51%) and 99 (99/224,44.2%) lesions showed local progression at a median of 289.5 days (Q1: 125, Q3: 452; range: 51–2245 days). Pre-treatment, international normalization ratio (INR) (1.17 ± 0.15 [SD] vs. 1.25 ± 0.16 [SD]; P <0.001), model for end-stage liver disease (9.4 ± 2.6 [SD] vs. 10.6 ± 3.2 [SD]; P = 0.010) and Child-Pugh score (6 ± 1 [SD] vs. 6.4 ± 1.3 [SD]; P = 0.012) were significantly lower while albumin serum level (3.4 ± 0.62 [SD] vs. 3.22 ± 0.52 [SD]; P = 0.033) was significantly greater in those who showed local progression as compared to those who did not. In terms of local-recurrence free survival, the number of TACE treatments (hazard ratio [HR]: 2.05 [95% CI: 1.57–2.67]; P<0.001), INR (HR: 0.13 [95% CI: 0.03–0.61]; P = 0.010) and type of TACE (P = 0.003) were significant. Patients with local progression on any tumor did not differ from those who did in terms of overall survival (P = 0.072), however, were less likely to be transplanted (20/75, 26.7%) than those who did not (33/72; 36.1%) (P = 0.016).
Conclusion |
A significant number of patients who achieve CR of HCC after TACE have local progression. This emphasizes the importance of long-term follow up.
Le texte complet de cet article est disponible en PDF.Keywords : End stage liver disease, Interventional radiology, Hepatocellular carcinoma, Survival studies, Therapeutic chemoembolization
Plan
Vol 103 - N° 3
P. 143-149 - mars 2022 Retour au numéro
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