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CC BY-NC-ND 4.0 · Journal of Clinical Interventional Radiology ISVIR 2023; 07(03): 141-146
DOI: 10.1055/s-0042-1756647
Original Article

Predictors of Refractoriness and Survival following Transarterial Chemoembolization for Hepatocellular Carcinoma: Outcomes from a Southeast Asian Cohort

Rudolf V. Kuhn 
1   Department of Medical Imaging and Therapeutic Radiology, National Kidney and Transplant Institute, East Avenue, Quezon City, Philippines
,
Glenn Marc G. Ignacio
1   Department of Medical Imaging and Therapeutic Radiology, National Kidney and Transplant Institute, East Avenue, Quezon City, Philippines
,
Jade D. Jamias 
2   Division of Internal Medicine, National Kidney and Transplant Institute, East Avenue, Quezon City, Philippines
,
Catherine S.C. Teh 
3   Department of Surgery, National Kidney and Transplant Institute, East Avenue, Quezon City, Philippines
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Abstract

Purpose Patients with hepatocellular carcinoma (HCC) become refractory to repeated sessions of transarterial chemoembolization (TACE). The aim of this study was to identify predictors associated with overall survival and refractoriness following repetitive TACE of HCC among patients in Southeast Asia.

Methods The clinical and laboratory characteristics and radiologic response of 39 patients treated with conventional TACE (range 2 to 5) with mitomycin from January 2012 to June 2018 were retrospectively analyzed. Patients were mostly male with a median age of 59 years and belonged to the BCLC B stage with a median tumor size of 7.5 cm.

Results The median overall survival was 23.2 months and the overall mortality at 5 years was 36%. Multivariate Cox regression analysis revealed that Child–Pugh (CP) score (hazard ratio [HR] = 3.47, p = 0.044), AST (HR = 7.6, p = 0.021), tumor size (HR = 5.47, p = 0.033), progressive disease on Choi criteria (HR = 5.47, confidence interval [CI] 1.15–25.99, p = 0.033), neutrophil-lymphocyte ratio (HR = 1.25, p = 0.049), and nodular enhancement on follow-up computed tomography (CT; HR = 1.98, p = 0.034) were independent risk factors for poor survival. ALT (p = 0.005), enhancement (p = 0.003), CP score (p = 0.010), and progressive disease on Choi criteria (p = 0.022) were predictive of TACE refractoriness/failure.

Conclusion Elevated liver enzymes, CP score, and progressive disease on Choi criteria accurately predict TACE refractoriness and failure, allowing early identification of patients who might benefit from other therapies.

Keywords

TACE - liver cancer - response - survival

Ethical Approval

This work is an original research work of the authors and has been approved by the Research Ethics Committee of the National Kidney and Transplant Institute, Philippines. It follows international guidelines on the ethical conduct of research, including the Declaration of Helsinki and the Committee on Publication Ethics.




Publication History

Article published online:
29 September 2022

© 2022. Indian Society of Vascular and Interventional Radiology. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Jemal A, Siegel R, Ward E. et al. Cancer statistics, 2008. CA Cancer J Clin 2008; 58 (02) 71-96
    CrossrefPubMedGoogle Scholar
  • 2 Raoul J-L, Gilabert M, Piana G. How to define transarterial chemoembolization failure or refractoriness: a European perspective. Liver Cancer 2014; 3 (02) 119-124
    CrossrefPubMedGoogle Scholar
  • 3 Hayano K, Lee SH, Sahani DV. Imaging for assessment of treatment response in hepatocellular carcinoma: current update. Indian J Radiol Imaging 2015; 25 (02) 121-128
    Article in Thieme ConnectPubMedGoogle Scholar
  • 4 Ronot M, Bouattour M, Wassermann J. et al. Alternative Response Criteria (Choi, European association for the study of the liver, and modified Response Evaluation Criteria in Solid Tumors [RECIST]) Versus RECIST 1.1 in patients with advanced hepatocellular carcinoma treated with sorafenib. Oncologist 2014; 19 (04) 394-402
    CrossrefPubMedGoogle Scholar
  • 5 Kudo M, Matsui O, Izumi N. et al; Liver Cancer Study Group of Japan. Transarterial chemoembolization failure/refractoriness: JSH-LCSGJ criteria 2014 update. Oncology 2014; 87 (Suppl. 01) 22-31
    CrossrefPubMedGoogle Scholar
  • 6 Kim HY, Park J-W, Joo J. et al. Severity and timing of progression predict refractoriness to transarterial chemoembolization in hepatocellular carcinoma. J Gastroenterol Hepatol 2012; 27 (06) 1051-1056
    CrossrefPubMedGoogle Scholar
  • 7 Tseng C-L, Lai W-J, Huang C-J. et al. The effectiveness of ART score in selecting patients for transarterial chemoembolization retreatment: a cohort study in Taiwan. Medicine (Baltimore) 2015; 94 (47) e1659
    CrossrefPubMedGoogle Scholar
  • 8 Terzi E, Terenzi L, Venerandi L. et al. The ART score is not effective to select patients for transarterial chemoembolization retreatment in an Italian series. Dig Dis 2014; 32 (06) 711-716
    CrossrefPubMedGoogle Scholar
  • 9 Sieghart W, Hucke F, Pinter M. et al. The ART of decision making: retreatment with transarterial chemoembolization in patients with hepatocellular carcinoma. Hepatology 2013; 57 (06) 2261-2273
    CrossrefPubMedGoogle Scholar
  • 10 Zhou D, Liang J, Xu LI. et al. Derived neutrophil to lymphocyte ratio predicts prognosis for patients with HBV-associated hepatocellular carcinoma following transarterial chemoembolization. Oncol Lett 2016; 11 (05) 2987-2994
    CrossrefPubMedGoogle Scholar
  • 11 Xiao WK, Chen D, Li SQ, Fu SJ, Peng BG, Liang LJ. Prognostic significance of neutrophil-lymphocyte ratio in hepatocellular carcinoma: a meta-analysis. BMC Cancer 2014; 14: 117
    CrossrefPubMedGoogle Scholar
  • 12 Liu C, Li L, Lu WS. et al. Neutrophil-lymphocyte ratio plus prognostic nutritional index predicts the outcomes of patients with unresectable hepatocellular carcinoma after transarterial chemoembolization. Sci Rep 2017; 7 (01) 13873
    CrossrefPubMedGoogle Scholar
  • 13 Ngelangel CA, Wang EH. Cancer and the Philippine Cancer Control Program. Jpn J Clin Oncol 2002; 32 (32, Suppl) S52-S61
    CrossrefPubMedGoogle Scholar