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Predisposing Factors of Hepatocellular Carcinoma Recurrence Following Complete Remission in Response to Transarterial Chemoembolization

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Abstract

Background and Aim

The aim of our study was to determine the predictors of recurrences in hepatocellular carcinoma (HCC) patients who had achieved complete remission (CR) by transarterial chemoembolization (TACE).

Methods

A total of 220 consecutive HCC patients who had achieved CR by TACE were followed for a median 72 months. CR was defined as complete lipiodol uptake based on the results of lipiodol-computed tomography 4 weeks after TACE and no additional tumor staining on the follow-up angiography. Recurrence patterns were classified as local recurrence and secondary tumor, respectively, in relation to the location of recurrence; early and late recurrence were classified in relation to recurrence time.

Results

Recurrence of HCC was observed in 169 patients (77 %), of whom 91 (54 %) had local recurrences, 61 (36 %) had secondary tumor, and 17 (10 %) had both. There were 45 (27 %) early and 124 (73 %) late recurrences. Local recurrence developed more frequently in patients with early recurrence than in those with late recurrence (62 vs. 51 %, respectively), while secondary tumor was detected more commonly in patients with late recurrence than in those with early recurrence (39 vs. 29 %, respectively; P < 0.001). In multivariate analyses, multinodularity [hazard ratio (HR) 2.351, P = 0.023] and a persistently high serum alpha-fetoprotein level following CR (HR 3.173, P < 0.001) were significant predictors of early recurrence. Older age (≥60 years; HR 1.531, P = 0.043), advanced Child–Pugh class (HR 1.983, P = 0.002), and the association with cirrhosis (HR 1.756, P = 0.028) were predictors of late recurrence following CR.

Conclusions

Early recurrences following CR by TACE may be due mainly to undetectable remaining tumors, whereas late recurrences may be caused by newly appearing tumors in patients with a background of advanced cirrhotic liver.

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Abbreviations

AFP:

Alpha-fetoprotein

CR:

Complete remission

CT:

Computed tomography

CTP:

Child–Turcotte–Pugh

HCC:

Hepatocellular carcinoma

LDCT:

Liver dynamic computed tomography

MRI:

Magnetic resonance imaging

TACE:

Transarterial chemoembolization

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Authors and Affiliations

  1. Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Korea

    Young-Joo Jin, Young-Hwa Chung, Jeong A. Kim, Wonhyeong Park, Don Lee, Ju Hyun Shim, Danbi Lee, Kang Mo Kim, Young-Suk Lim, Han Chu Lee & Yung Sang Lee

  2. Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea

    Pyo Nyun Kim & Kyu Bo Sung

Authors
  1. Young-Joo Jin
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  2. Young-Hwa Chung
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  3. Jeong A. Kim
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  4. Wonhyeong Park
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  5. Don Lee
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  6. Ju Hyun Shim
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  7. Danbi Lee
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  8. Kang Mo Kim
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  9. Young-Suk Lim
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  10. Han Chu Lee
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  11. Yung Sang Lee
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  13. Kyu Bo Sung
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Correspondence to Young-Hwa Chung.

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Jin, YJ., Chung, YH., Kim, J.A. et al. Predisposing Factors of Hepatocellular Carcinoma Recurrence Following Complete Remission in Response to Transarterial Chemoembolization. Dig Dis Sci 58, 1758–1765 (2013). https://doi.org/10.1007/s10620-013-2562-8

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  • DOI: https://doi.org/10.1007/s10620-013-2562-8

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