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Correlation between SACE (Subjective Angiographic Chemoembolization Endpoint) score and tumor response and its impact on survival after DEB-TACE in patients with hepatocellular carcinoma

  • Interventional Radiology
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Abstract

Purpose

To asses angiographic and computed tomographic success criteria during and after transcatheter arterial drug-eluting bead chemoembolization (DEB-TACE) in patients with hepatocellular carcinoma (HCC) and its impact on progression-free survival (PFS) and overall survival (OS).

Methods

In this retrospective single-center study, 50 patients with unresectable HCC having undergone DEB-TACE from January 2010 to July 2015 were assessed. The angiographic endpoint was classified by Subjective Angiographic Chemoembolization Endpoint (SACE) scale. Relative tumor density in arterial (DArt) and portal venous phase (DPV) computed tomography post- versus pre-DEB-TACE were calculated, respectively. Tumor response according to modified Response Criteria in Solid Tumors (mRECIST) was assessed. Univariate Kaplan–Meier and Cox regression analysis were carried out.

Results

SACE scores I, II, III, and IV were found in 1 (2%), 20 (40%), 15 (30%), and 14 (28%) patients, respectively. Median OS and PFS were 14.2 and 5.5 months, respectively. Death rates at 6 months, 1 year and 2 years were 24%, 38%, and 52%, respectively. SACE score during DEB-TACE significantly correlated with local and overall mRECIST results (local: p < 0.001, r = 0.49, overall: p = 0.042, r = 0.29) and inversely correlated with DPV (p = 0.005, r = − 0.40). In univariate analysis, progressive disease (PD) according to mRECIST and increase of DArt and DPV were associated with significantly shorter PFS. Modified RECIST independently predicted OS (hazard ratio for complete remission vs. PD = 0.15, 95% confidence interval 0.03–0.68, p = 0.014).

Conclusions

A direct impact of SACE on PFS or OS could not be shown. However, SACE significantly correlated with local and overall mRECIST tumor response that again significantly predicted OS. We therefore postulate an indirect impact of SACE on OS. Consequently, complete embolization should be attempted.

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Acknowledgements

The authors would like to thank PD Dr. Med. Bruno Neuner, Campus Virchow-Hospital, Charité Berlin, as well as Sebastian Häckl and Florian Lasch, Institute for Biometry, Hannover Medical School for their statistical guidance throughout the study.

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Authors and Affiliations

  1. Department of General and Visceral Surgery and Surgical Oncology, Asklepios Klinik Barmbek, Rübenkamp 220, 22307, Hamburg, Germany

    Victoria Susanne Antonia Habbel & Karl-Jürgen Oldhafer

  2. Semmelweis Medical Faculty, Asklepios Campus Hamburg, Lohmühlenstraße 5, 20099, Hamburg, Germany

    Victoria Susanne Antonia Habbel, Gregor Alexander Stavrou & Karl-Jürgen Oldhafer

  3. Department of Diagnostic and Interventional Radiology, Marienkrankenhaus GmbH, Alfredstraße 9, 22087, Hamburg, Germany

    Martin Zeile

  4. Department of General, Visceral, Thoracic and Pediatric Surgery, Klinikum Saarbrücken, Winterberg 1, 66119, Saarbrücken, Germany

    Gregor Alexander Stavrou

  5. Department of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany

    Frank Wacker & Thomas Rodt

  6. Department of Diagnostic and Interventional Radiology, Asklepios Klinik Barmbek, Rübenkamp 220, 22307, Hamburg, Germany

    Roland Brüning

  7. Department of Diagnostic and Interventional Radiology / Neuroradiology and Nuclear Medicine, Klinikum Lueneburg, Boegelstr. 1, 21339, Lüneburg, Germany

    Thomas Rodt

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Correspondence to Victoria Susanne Antonia Habbel.

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This study was reviewed and approved by the Ethical Committee of Hannover Medical School, Germany.

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Habbel, V.S.A., Zeile, M., Stavrou, G.A. et al. Correlation between SACE (Subjective Angiographic Chemoembolization Endpoint) score and tumor response and its impact on survival after DEB-TACE in patients with hepatocellular carcinoma. Abdom Radiol 44, 3463–3479 (2019). https://doi.org/10.1007/s00261-019-02128-7

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