Original Article

Hepatology International

, Volume 5, Issue 4, pp 975-984

Early identification of poor responders to transarterial chemoembolization for hepatocellular carcinoma

  • Ya-Ju TsaiAffiliated withSchool of Nursing, National Yang-Ming UniversityDepartment of Nursing, Taipei Veterans General HospitalSchool of Nursing, University of Michigan
  • , Chia-Yang HsuAffiliated withFaculty of Medicine, National Yang-Ming UniversityDepartment of Medicine, Taipei Veterans General HospitalDepartment of Medicine, National Yang-Ming University Hospital
  • , Yi-Hsiang HuangAffiliated withInstitute of Clinical Medicine, National Yang-Ming University
  • , Chien-Wei SuAffiliated withFaculty of Medicine, National Yang-Ming UniversityDepartment of Medicine, Taipei Veterans General Hospital
  • , Han-Chieh LinAffiliated withFaculty of Medicine, National Yang-Ming UniversityDepartment of Medicine, Taipei Veterans General Hospital
  • , Rheun-Chuan LeeAffiliated withFaculty of Medicine, National Yang-Ming UniversityDepartment of Radiology, Taipei Veterans General Hospital
  • , Jen-Huey ChiangAffiliated withFaculty of Medicine, National Yang-Ming UniversityDepartment of Radiology, Taipei Veterans General Hospital
  • , Teh-Ia HuoAffiliated withDepartment of Medicine, Taipei Veterans General HospitalInstitute of Pharmacology, National Yang-Ming University Email author 
  • , Shou-Dong LeeAffiliated withFaculty of Medicine, National Yang-Ming UniversityDepartment of Medicine, Taipei Veterans General Hospital

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Abstract

Purpose

Transarterial chemoembolization (TACE) is used to treat unresectable hepatocellular carcinoma (HCC). However, HCC patients may have an even shorter survival after TACE. This study aimed to identify poor responders to TACE at an early stage.

Patients and methods

A total of 624 and 122 patients with HCC undergoing TACE and best supportive care (BSC), respectively, were analyzed. Poor responders were defined as patients who died after TACE or had viable tumor(s), but not eligible for further treatment at 3 months of treatment.

Results

A total of 102 (16%) patients were identified as poor responders. Poor responders had a significantly decreased long-term survival than other patients receiving TACE and a tendency of higher risk of mortality than patients receiving BSC (p < 0.001 and p = 0.054, respectively). The comparison of 24-month survival showed significantly worse outcome in poor responders than patients receiving BSC (p = 0.04). Serum α-fetoprotein (AFP) level >40 ng/mL (p = 0.024) and albumin level 3.8 g/dL (p = 0.016), Child-Turcotte-Pugh (CTP) class B (p = 0.011), performance status 1 (p < 0.001), total tumor volume (TTV) >65 cm3 (p = 0.001), and vascular invasion (p = 0.005) were independent risk factors predicting poor response at 3 months in the multivariate logistic regression analysis. Among the four HCC staging systems, the Barcelona Clinic Liver Cancer (BCLC) classification showed the highest predictive accuracy for the identification of poor responders.

Conclusions

Poor responders have an increased risk of mortality due to rapid disease progression after TACE. Advanced BCLC stages may better predict a poor response to TACE.

Keywords

Barcelona Clinic Liver Cancer (BCLC) Best supportive care Hepatocellular carcinoma Transarterial chemoembolization Total tumor volume