Download PDF
Digestive Disease Interventions 2023; 07(03): 169-179
DOI: 10.1055/s-0043-1760728
Review Article

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 Patients

Justin J. Guan 
1   Division of Interventional Radiology, Department of Diagnostic Radiology, Cleveland Clinic, Cleveland, Ohio
,
Sandeep T. Laroia
2   Division of Interventional Radiology, Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
,
Aaron F. McBride
1   Division of Interventional Radiology, Department of Diagnostic Radiology, Cleveland Clinic, Cleveland, Ohio
,
Shiliang Sun
2   Division of Interventional Radiology, Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
,
Lihong Huang
3   Department of Biostatistics, Zhongshan Hospital, Fudan University, Shanghai, China
,
Jingzhen Yang
4   Center for Injury Research and Policy, Nationwide Children's Hospital, Columbus, Ohio
,
Michael Dunlay
5   Department of Radiology, Mayo Clinic, Rochester, Minnesota
,
Prashant Nagpal
6   Department of Radiology, University of Wisconsin–Madison, Madison, Wisconsin
› Author Affiliations Funding This study was not supported by any funding.
› Further Information
Also available at
    Permissions and Reprints

Abstract

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.

Keywords

hepatocellular cancer - TACE - chemoembolization

Ethical Approval

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.


Informed Consent

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.




Publication History

Received: 20 July 2022

Accepted: 08 December 2022

Article published online:
10 March 2023

© 2023. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 8 Bruix J, Llovet JM. Prognostic prediction and treatment strategy in hepatocellular carcinoma. Hepatology 2002; 35 (03) 519-524
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 13 Llovet JM, Brú C, Bruix J. Prognosis of hepatocellular carcinoma: the BCLC staging classification. Semin Liver Dis 1999; 19 (03) 329-338
    Article in Thieme ConnectPubMedGoogle Scholar
  • 14 Llovet JM, Bruix J. Systematic review of randomized trials for unresectable hepatocellular carcinoma: chemoembolization improves survival. Hepatology 2003; 37 (02) 429-442
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 26 Lencioni R, Llovet JM. Modified RECIST (mRECIST) assessment for hepatocellular carcinoma. Semin Liver Dis 2010; 30 (01) 52-60
    Article in Thieme ConnectPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar