Skip to main content
SpringerLink
Log in

The efficacy of transarterial chemoembolization in downstaging unresectable hepatocellular carcinoma to curative therapy: a predicted regression model

  • Review
  • Published:
Investigational New Drugs Aims and scope Submit manuscript

Abstract

Patients with hepatocellular carcinoma (HCC) outside Milan criteria (MC) may be candidates for curative therapy after successful downstaging. We aimed to identify the predictors of successful downstaging of unresectable HCC in patient by transarterial chemoembolization (TACE) outside MC. We performed a retrospective study on patients with unresectable HCC outside MC who received downstaging with TACE. Clinical and laboratory variables were recorded. We identified 101 patients with unresectable HCC who underwent initial TACE, who formed the derivation set of this study. Thirty patients who treated by TACE with the same selection criteria served as an external validation set. We performed univariate and multivariate logistic regression analyses to identify variables associated with successful downstaging. Then we did the predictive model to predict the efficiency of TACE. Of the 101 patients in the study, 26 patients (25.7%) were successfully downstaging and 75 patients (74.3%) failed downstaging. Multivariate analysis of factors to predict successful downstaging of HCC outside MC the number of tumor (P = 0.01), portal vein tumor thrombosis (PVTT)(p < 0.01), the size of tumor (P = 0.02), hepatitis B surface antigen (HBsAg) (P = 0.01), α-fetoprotein (AFP) (P = 0.02) as significant predictors of successful downstaging. Then we constructed the predictive model. The area under the ROC curve (AUROC) of the predictive equation was 0.90 (95% confidence interval, 0.83–0.95). We found in our study that the number and size of tumors, PVTT, HBsAg, and AFP are good predictors of successful downstaging of unresectable HCC in patients by TACE outside the MC.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Data availability

Haomin Lin should be contacted if someone wants to request the data.

References

  1. Titano J, Voutsinas N, Kim E (2019) The Role of Radioembolization in Bridging and Downstaging Hepatocellular Carcinoma to Curative Therapy. Semin Nucl Med 49(3):189–196

    Article  Google Scholar 

  2. Kim Y et al (2017) Downstaging therapy followed by liver transplantation for hepatocellular carcinoma beyond Milan criteria. Surgery 162(6):1250–1258

    Article  Google Scholar 

  3. Villanueva A (2019) Hepatocellular Carcinoma. N Engl J Med 380(15):1450–1462

    Article  CAS  Google Scholar 

  4. Forner A, Reig M, Bruix J (2018) Hepatocellular carcinoma. Lancet 391(10127):1301–1314

    Article  Google Scholar 

  5. Murali AR et al (2016) Predictors of Successful Downstaging of Hepatocellular Carcinoma Outside Milan Criteria. Transplantation 100(11):2391–2397

    Article  CAS  Google Scholar 

  6. Parikh ND, Waljee AK, Singal AG (2015) Downstaging hepatocellular carcinoma: A systematic review and pooled analysis. Liver Transpl 21(9):1142–1152

    Article  Google Scholar 

  7. Jiang J et al (2017) Nomogram for individualized prediction of recurrence after postoperative adjuvant TACE for hepatitis B virus-related hepatocellular carcinoma. Medicine (Baltimore) 96(32):e7390

    Article  Google Scholar 

  8. Tang Q et al (2021) Efficacy and Safety of Transarterial Chemoembolization in Elderly Patients of Advanced Hepatocellular Carcinoma With Portal Vein Tumor Thrombus: A Retrospective Study. Front Oncol 11:646410

    Article  Google Scholar 

  9. Cai L et al (2021) Drug-eluting bead transarterial chemoembolization is an effective downstaging option for subsequent radical treatments in patients with hepatocellular carcinoma: A cohort study. Clin Res Hepatol Gastroenterol 45(4):101535

    Article  CAS  Google Scholar 

  10. Yasui Y et al (2018) Up-to-seven criteria as a useful predictor for tumor downstaging to within Milan criteria and Child-Pugh grade deterioration after initial conventional transarterial chemoembolization. Hepatol Res 48(6):442–450

    Article  CAS  Google Scholar 

  11. Yao FY et al (2015) Downstaging of hepatocellular cancer before liver transplant: long-term outcome compared to tumors within Milan criteria. Hepatology 61(6):1968–1977

    Article  Google Scholar 

  12. Wang X, Wang Q (2018) Alpha-Fetoprotein and Hepatocellular Carcinoma Immunity. Can J Gastroenterol Hepatol 2018:9049252

    PubMed  PubMed Central  Google Scholar 

  13. Liu PH, Huo TI, Miksad RA (2018) Hepatocellular Carcinoma with Portal Vein Tumor Involvement: Best Management Strategies. Semin Liver Dis 38(3):242–251

    Article  CAS  Google Scholar 

  14. Poon RT et al (2000) Long-term prognosis after resection of hepatocellular carcinoma associated with hepatitis B-related cirrhosis. J Clin Oncol 18(5):1094–1101

    Article  CAS  Google Scholar 

  15. Qiu JF et al (2017) Pre- and post-operative HBsAg levels may predict recurrence and survival after curative resection in patients with HBV-associated hepatocellular carcinoma. J Surg Oncol 116(2):140–148

    Article  CAS  Google Scholar 

  16. Toso C et al (2009) Reassessing selection criteria prior to liver transplantation for hepatocellular carcinoma utilizing the Scientific Registry of Transplant Recipients database. Hepatology 49(3):832–838

    Article  Google Scholar 

  17. Zakaria HM et al (2020) Total tumor volume as a prognostic value for survival following liver resection in patients with hepatocellular carcinoma. Retrospective cohort study Ann Med Surg (Lond) 54:47–53

    Google Scholar 

  18. Kudo M et al (2011) Phase III study of sorafenib after transarterial chemoembolisation in Japanese and Korean patients with unresectable hepatocellular carcinoma. Eur J Cancer 47(14):2117–2127

    Article  CAS  Google Scholar 

  19. Zhu Q et al (2015) Arterial blood supply of hepatocellular carcinoma is associated with efficacy of sorafenib therapy. Ann Transl Med 3(19):285

    PubMed  PubMed Central  Google Scholar 

  20. Dinh VY et al (2016) Pilot Study of Intrahepatic Artery Chemotherapy in Combination with Sorafenib in Hepatocellular Carcinoma. Anticancer Res 36(7):3555–3563

    CAS  PubMed  Google Scholar 

Download references

Funding

This work was supported by the National Natural Science Foundation of China (81803019).

Author information

Author notes

  1. Haomin Lin, Bin Luo and Fangyi Peng share first authorship.

Authors and Affiliations

  1. Department of General Surgery (Hepatobiliary Surgery), The Affiliated Hospital of Southwest Medical University, Sichuan Province, Luzhou City, China

    Haomin Lin, Bin Luo, Fangyi Peng, Cheng Fang, Yu Gan, Xiaoli Yang, Bo Li & Song Su

  2. School of Pharmacy, Southwest Medical University, Sichuan Province, Luzhou City, China

    Yaling Li

Authors
  1. Haomin Lin
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Bin Luo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Fangyi Peng
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Cheng Fang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yu Gan
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Xiaoli Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Bo Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Yaling Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Song Su
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

SS and YL designed the study, HL, FP and BL and prepared first and final draft of the article; YG, CF and XY recorded the clinical and laboratory variables and prepared Table-1 and Table-2; HL and BL performed univariate and multivariate logistic regression analyses to identify the variables associated with successful downstaging and prepared Figure-1 and Figure-2. SS is corresponding author, provided critical feedback and helped to modify manuscript. All authors reviewed the manuscript. The authors deny any conflicts of interest.

Corresponding authors

Correspondence to Yaling Li or Song Su.

Ethics declarations

Ethics approval

This retrospective experiment has been approved by the Clinical Trial Ethics Committee of The Affiliated Hospital of Southwest Medical University, China (Acceptance Number:KY2021156).

Informed consent

Informed consent is an oral or written consent obtained from all participating adult experimenters and the parents or legal guardians of minors or incapacitated adults.

Consent to participate

Informed consent was obtained from all individual participants included in the study.

Consent to publish

The authors affirm that human research participants provided informed consent for publication of the clinical and laboratory variables.

Competing interests

The authors deny any conflicts of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lin, H., Luo, B., Peng, F. et al. The efficacy of transarterial chemoembolization in downstaging unresectable hepatocellular carcinoma to curative therapy: a predicted regression model. Invest New Drugs 40, 1146–1152 (2022). https://doi.org/10.1007/s10637-022-01261-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10637-022-01261-3

Keywords

Search

Navigation