Hepatology International

, Volume 5, Issue 4, pp 975–984

Early identification of poor responders to transarterial chemoembolization for hepatocellular carcinoma

  • Ya-Ju Tsai
  • Chia-Yang Hsu
  • Yi-Hsiang Huang
  • Chien-Wei Su
  • Han-Chieh Lin
  • Rheun-Chuan Lee
  • Jen-Huey Chiang
  • Teh-Ia Huo
  • Shou-Dong Lee
Original Article

DOI: 10.1007/s12072-011-9276-9

Cite this article as:
Tsai, YJ., Hsu, CY., Huang, YH. et al. Hepatol Int (2011) 5: 975. doi:10.1007/s12072-011-9276-9

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 careHepatocellular carcinomaTransarterial chemoembolizationTotal tumor volume

Abbreviations

AASLD

American Association of the Study of Liver Disease

AFP

α-Fetoprotein

BCLC

Barcelona Clinic Liver Cancer

BSC

Best supportive care

CI

Confidence interval

CLIP

Cancer of the Liver Italian Program

CT

Computed tomography

CTP

Child-Turcotte-Pugh

HBV

Hepatitis B virus

HCV

Hepatitis C virus

HCC

Hepatocellular carcinoma

MRI

Magnetic resonance imaging

SD

Standard deviation

TACE

Transarterial chemoembolization

TTV

Total tumor volume

Copyright information

© Asian Pacific Association for the Study of the Liver 2011

Authors and Affiliations

  • Ya-Ju Tsai
    • 1
    • 2
    • 3
  • Chia-Yang Hsu
    • 4
    • 5
    • 6
  • Yi-Hsiang Huang
    • 7
  • Chien-Wei Su
    • 4
    • 5
  • Han-Chieh Lin
    • 4
    • 5
  • Rheun-Chuan Lee
    • 4
    • 8
  • Jen-Huey Chiang
    • 4
    • 8
  • Teh-Ia Huo
    • 5
    • 9
  • Shou-Dong Lee
    • 4
    • 5
  1. 1.School of NursingNational Yang-Ming UniversityTaipeiTaiwan
  2. 2.Department of NursingTaipei Veterans General HospitalTaipeiTaiwan
  3. 3.School of NursingUniversity of MichiganAnn ArborUSA
  4. 4.Faculty of MedicineNational Yang-Ming UniversityTaipeiTaiwan
  5. 5.Department of MedicineTaipei Veterans General HospitalTaipeiTaiwan
  6. 6.Department of MedicineNational Yang-Ming University HospitalYilanTaiwan
  7. 7.Institute of Clinical MedicineNational Yang-Ming UniversityTaipeiTaiwan
  8. 8.Department of RadiologyTaipei Veterans General HospitalTaipeiTaiwan
  9. 9.Institute of PharmacologyNational Yang-Ming UniversityTaipeiTaiwan