Early identification of poor responders to transarterial chemoembolization for hepatocellular carcinoma
- 177 Downloads
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.
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.
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.
KeywordsBarcelona Clinic Liver Cancer (BCLC) Best supportive care Hepatocellular carcinoma Transarterial chemoembolization Total tumor volume
American Association of the Study of Liver Disease
Barcelona Clinic Liver Cancer
Best supportive care
Cancer of the Liver Italian Program
Hepatitis B virus
Hepatitis C virus
Magnetic resonance imaging
Total tumor volume
- 1.Omata M, Lesmana LA, Tateishi R, Chen PJ, Lin SM, Yoshida H, Kudo M, Lee JM, Choi BI, Poon RT, Shiina S, Cheng AL, Jia JD, Obi S, Han KH, Jafri W, Chow P, Lim SG, Chawla YK, Budihusodo U, Gani RA, Lesmana CR, Putranto TA, Liaw YF, Sarin SK. Asian Pacific Association for the Study of the Liver consensus recommendations on hepatocellular carcinoma. Hepatol Int 2010;4:439–474PubMedCrossRefGoogle Scholar
- 10.Bruix J, Llovet JM, Castells A, Montana X, Bru C, Ayuso MC, Vilana R, Rodes J. Transarterial embolization versus symptomatic treatment in patients with advanced hepatocellular carcinoma: Results of a randomized, controlled trial in a single institution. Hepatology 1998;27:1578–1583PubMedCrossRefGoogle Scholar
- 11.CLIP Group (Cancer of the Liver Italian Program) Tamoxifen in treatment of hepatocellular carcinoma: a randomised controlled trial. Lancet 1998;352:17–20.Google Scholar
- 12.Grieco A, Pompili M, Caminiti G, Miele L, Covino M, Alfei B, Rapaccini GL, Gasbarrini G. Prognostic factors for survival in patients with early-intermediate hepatocellular carcinoma undergoing non-surgical therapy: comparison of Okuda, CLIP, and BCLC staging systems in a single Italian centre. Gut 2005;54:411–418PubMedCrossRefGoogle Scholar
- 14.Huang YH, Chen CH, Chang TT, Chen SC, Wang SY, Lee HS, Lin PW, Huang GT, Sheu JC, Tsai HM, Lee PC, Chau GY, Lui WY, Lee SD, Wu JC. Evaluation of predictive value of CLIP Okuda, TNM and JIS staging systems for hepatocellular carcinoma patients undergoing surgery. J Gastroenterol Hepatol 2005;20:765–771PubMedCrossRefGoogle Scholar
- 16.Bruix J, Sherman M, Llovet JM, Beaugrand M, Lencioni R, Burroughs AK, Christensen E, Pagliaro L, Colombo M, Rodes J. Clinical management of hepatocellular carcinoma. Conclusions of the Barcelona-2000 EASL conference. European Association for the Study of the Liver. J Hepatol 2001;35:421–430PubMedCrossRefGoogle Scholar
- 18.Huo TI, Huang YH, Lin HC, Wu JC, Chiang JH, Lee PC, Chang FY, Lee SD. Proposal of a modified Cancer of the Liver Italian Program staging system based on the model for end-stage liver disease for patients with hepatocellular carcinoma undergoing loco-regional therapy. Am J Gastroenterol 2006;101:975–982PubMedCrossRefGoogle Scholar
- 20.Liver Including Intrahepatic Bile Ducts. In Greene F, Page D, Fleming I, eds. American Joint Committee on Cancer Staging Manual. 6th ed. New York: Springer, 2002;131–144Google Scholar
- 21.The Cancer of the Liver Italian Program (CLIP) Investigators. Prospective validation of the CLIP score: A new prognostic system for patients with cirrhosis and hepatocellular carcinoma. Hepatology 2000;31:840–845Google Scholar
- 23.Groupe d’Etude et de Traitement du Carcinome Hepatocellulaire A comparison of lipiodol chemoembolization and conservative treatment for unresectable hepatocellular carcinoma. N Engl J Med 1995;332:1256–1261Google Scholar
- 27.Camma C, Di Marco V, Cabibbo G, Latteri F, Sandonato L, Parisi P, Enea M, Attanasio M, Galia M, Alessi N, Licata A, Latteri MA, Craxi A. Survival of patients with hepatocellular carcinoma in cirrhosis: a comparison of BCLC, CLIP and GRETCH staging systems. Aliment Pharmacol Ther 2008;28:62–75PubMedCrossRefGoogle Scholar