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Presence of an Arterial Feeding Vessel on Cross-Sectional Imaging Predicts Treatment Response and Survival after Transarterial Chemoembolization for Unresectable Hepatocellular Carcinoma: A Retrospective Multivariable Analysis of 138 PatientsFunding This study was not supported by any funding.
Finding a feeding vessel with diameter greater than 0.9 mm during transarterial chemoembolization (TACE) for hepatocellular cancer (HCC) has been shown to predict tumor necrosis on subsequent pathology. However, whether this translates into a useful clinical predictor for post-chemoembolization response and survival is unknown. This study aimed to determine whether the presence of an arterial feeder on pre-TACE cross-sectional imaging is associated with treatment response and survival after TACE for unresectable HCC. Retrospective medical record search for all chemo-embolizations performed for HCC from 2015 to 2016 yielded 138 patients who underwent 275 TACE sessions spanning 2011 to 2017. Patients consisted of 98 males (71%) with mean age of 62 (range, 37–86). Each patient underwent an average of two TACE sessions (range, 1–11). Endpoints included target tumor response and overall response defined by the mRECIST criteria, as well as patient survival. Preprocedural MRI/CT was reviewed for the presence of arterial feeder. Multivariable logistic regressions and Cox proportional hazard regressions were used to assess the effects of arterial feeder presence on treatment response and survival, respectively, adjusting for other covariates. Overall response was seen in 69% of patients. Arterial feeder was present on preprocedural cross-sectional imaging for 28% of TACE sessions. Median survival was 26.5 months (interquartile range, 13.2–38.1). The presence of arterial feeder led to better target tumor response (OR = 11.9, p < 0.0001), overall response (OR = 9.3, p < 0.0001), and improved survival (HR = 0.55, p = 0.02). The presence of an arterial feeder on pre-TACE cross-sectional imaging is associated with target tumor response, overall response, and survival after TACE.
For this type of study, no formal consent is required. This study was approved by the Institutional Review Board at the University of Iowa Hospitals and Clinics, where data were collected and analyzed.
This study has obtained IRB approval from the University of Iowa Hospitals and Clinics, and the need for informed consent was waived.
Consent for Publication
For this type of study, consent for publication is not required.
Received: 20 July 2022
Accepted: 08 December 2022
Article published online:
10 March 2023
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- 1 Yang JD, Hainaut P, Gores GJ, Amadou A, Plymoth A, Roberts LR. A global view of hepatocellular carcinoma: trends, risk, prevention and management. Nat Rev Gastroenterol Hepatol 2019; 16 (10) 589-604
- 2 Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2018; 68 (06) 394-424
- 3 Hu HT, Kim JH, Lee LS. et al. Chemoembolization for hepatocellular carcinoma: multivariate analysis of predicting factors for tumor response and survival in a 362-patient cohort. J Vasc Interv Radiol 2011; 22 (07) 917-923
- 4 Robinson A, Tavakoli H, Liu B, Bhuket T, Wong RJ. Advanced hepatocellular carcinoma tumor stage at diagnosis in the 1945-1965 birth cohort reflects poor use of hepatocellular carcinoma screening. Hepatol Commun 2018; 2 (09) 1147-1155
- 5 Chang KH, Hwang ZA, Chang PY. et al. Predictive imaging for tumor response to drug-eluting microsphere transarterial chemoembolization in patients with BCLC-C advanced hepatocellular carcinoma. Sci Rep 2019; 9 (01) 20032
- 6 Wang Q, Xia D, Bai W. et al; China HCC-TACE Study Group. Development of a prognostic score for recommended TACE candidates with hepatocellular carcinoma: a multicentre observational study. J Hepatol 2019; 70 (05) 893-903
- 7 Katyal S, Oliver JH, Peterson MS, Chang PJ, Baron RL, Carr BI. Prognostic significance of arterial phase CT for prediction of response to transcatheter arterial chemoembolization in unresectable hepatocellular carcinoma: a retrospective analysis. AJR Am J Roentgenol 2000; 175 (06) 1665-1672
- 8 Bruix J, Llovet JM. Prognostic prediction and treatment strategy in hepatocellular carcinoma. Hepatology 2002; 35 (03) 519-524
- 9 Gokcan H, Savaş N, Oztuna D, Moray G, Boyvat F, Haberal M. Predictors of survival in hepatocellular carcinoma patients. Ann Transplant 2015; 20: 596-603
- 10 Cheng AL, Kang YK, Chen Z. et al. Efficacy and safety of sorafenib in patients in the Asia-Pacific region with advanced hepatocellular carcinoma: a phase III randomised, double-blind, placebo-controlled trial. Lancet Oncol 2009; 10 (01) 25-34
- 11 Bruix J, Takayama T, Mazzaferro V. et al; STORM Investigators. Adjuvant sorafenib for hepatocellular carcinoma after resection or ablation (STORM): a phase 3, randomised, double-blind, placebo-controlled trial. Lancet Oncol 2015; 16 (13) 1344-1354
- 12 Kwan SW, Fidelman N, Ma E, Kerlan Jr RK, Yao FY. Imaging predictors of the response to transarterial chemoembolization in patients with hepatocellular carcinoma: a radiological-pathological correlation. Liver Transpl 2012; 18 (06) 727-736
- 13 Llovet JM, Brú C, Bruix J. Prognosis of hepatocellular carcinoma: the BCLC staging classification. Semin Liver Dis 1999; 19 (03) 329-338
- 14 Llovet JM, Bruix J. Systematic review of randomized trials for unresectable hepatocellular carcinoma: chemoembolization improves survival. Hepatology 2003; 37 (02) 429-442
- 15 Aliberti C, Carandina R, Lonardi S. et al. Transarterial chemoembolization with small drug-eluting beads in patients with hepatocellular carcinoma: experience from a cohort of 421 patients at an Italian center. J Vasc Interv Radiol 2017; 28 (11) 1495-1502
- 16 Gaba RC, Lewandowski RJ, Hickey R. et al; Society of Interventional Radiology Technology Assessment Committee. Transcatheter therapy for hepatic malignancy: standardization of terminology and reporting criteria. J Vasc Interv Radiol 2016; 27 (04) 457-473
- 17 Kong JY, Li SM, Fan HY, Zhang L, Zhao HJ, Li SM. Transarterial chemoembolization extends long-term survival in patients with unresectable hepatocellular carcinoma. Medicine (Baltimore) 2018; 97 (33) e11872
- 18 Labeur TA, Takkenberg RB, Klümpen HJ, van Delden OM. Reason of discontinuation after transarterial chemoembolization influences survival in patients with hepatocellular carcinoma. Cardiovasc Intervent Radiol 2019; 42 (02) 230-238
- 19 Jia Z, Tu J, Cao C. et al. Liver abscess following transarterial chemoembolization for the treatment of hepatocellular carcinoma: a retrospective analysis of 23 cases. J Cancer Res Ther 2018; 14 (Suppl): S628-S633
- 20 Tu J, Jia Z, Ying X. et al. The incidence and outcome of major complication following conventional TAE/TACE for hepatocellular carcinoma. Medicine (Baltimore) 2016; 95 (49) e5606
- 21 Nagpal P, Bhalala M, Vidholia A. et al. Abdominal skin rash after TACE due to non-target embolization of hepatic falciform artery. ACG Case Rep J 2016; 3 (03) 217-220
- 22 Shen H, Agarwal D, Qi R. et al. Predictors of outcome in patients with unresectable hepatocellular carcinoma receiving transcatheter arterial chemoembolization. Aliment Pharmacol Ther 2007; 26 (03) 393-400
- 23 Shim JH, Park JW, Choi JI, Kim HB, Lee WJ, Kim CM. Does postembolization fever after chemoembolization have prognostic significance for survival in patients with unresectable hepatocellular carcinoma?. J Vasc Interv Radiol 2009; 20 (02) 209-216
- 24 Ngan H, Lai CL, Fan ST, Lai EC, Yuen WK, Tso WK. Transcatheter arterial chemoembolization in inoperable hepatocellular carcinoma: four-year follow-up. J Vasc Interv Radiol 1996; 7 (03) 419-425
- 25 Ebied OM, Federle MP, Carr BI. et al. Evaluation of responses to chemoembolization in patients with unresectable hepatocellular carcinoma. Cancer 2003; 97 (04) 1042-1050
- 26 Lencioni R, Llovet JM. Modified RECIST (mRECIST) assessment for hepatocellular carcinoma. Semin Liver Dis 2010; 30 (01) 52-60
- 27 Noussios G, Dimitriou I, Chatzis I, Katsourakis A. The main anatomic variations of the hepatic artery and their importance in surgical practice: review of the literature. J Clin Med Res 2017; 9 (04) 248-252
- 28 Asayama Y, Okamoto D, Ushijima Y. et al. Predictors of therapeutic effect of transarterial chemoembolisation using drug-eluting beads for hepatocellular carcinoma. Clin Radiol 2017; 72 (09) 780-785
- 29 Bryant MK, Dorn DP, Zarzour J. et al. Computed tomography predictors of hepatocellular carcinoma tumour necrosis after chemoembolization. HPB (Oxford) 2014; 16 (04) 327-335
- 30 Vesselle G, Quirier-Leleu C, Velasco S. et al. Predictive factors for complete response of chemoembolization with drug-eluting beads (DEB-TACE) for hepatocellular carcinoma. Eur Radiol 2016; 26 (06) 1640-1648
- 31 Kim BK, Kim KA, An C. et al. Prognostic role of magnetic resonance imaging vs. computed tomography for hepatocellular carcinoma undergoing chemoembolization. Liver Int 2015; 35 (06) 1722-1730
- 32 Lu DS, Siripongsakun S, Kyong Lee J. et al. Complete tumor encapsulation on magnetic resonance imaging: a potentially useful imaging biomarker for better survival in solitary large hepatocellular carcinoma. Liver Transpl 2013; 19 (03) 283-291
- 33 Wáng YX, De Baere T, Idée JM, Ballet S. Transcatheter embolization therapy in liver cancer: an update of clinical evidences. Chin J Cancer Res 2015; 27 (02) 96-121
- 34 Nguyen MH, Garcia RT, Simpson PW, Wright TL, Keeffe EB. Racial differences in effectiveness of alpha-fetoprotein for diagnosis of hepatocellular carcinoma in hepatitis C virus cirrhosis. Hepatology 2002; 36 (02) 410-417