Reason of Discontinuation After Transarterial Chemoembolization Influences Survival in Patients with Hepatocellular Carcinoma

Overview

Journal Cardiovasc Intervent Radiol

Specialty Cardiology & Vascular Diseases

Date 2018 Nov 30

PMID 30488302

Citations 10

Authors

Tim A Labeur

R Bart Takkenberg

Heinz-Josef Klumpen

Otto M van Delden

Affiliations

Soon will be listed here.

Abstract

Background: Transarterial chemoembolization (TACE) for intermediate-stage hepatocellular carcinoma (HCC) is often repeated until unTACEable progression (UTP) occurs. There is little data on the various reasons for stopping TACE and its consequences for subsequent treatment and survival.

Aim: To assess the impact of the various reasons of UTP on survival and consequences for subsequent treatments.

Methods: Consecutive HCC patients who underwent TACE between 2003 and 2016 were analyzed retrospectively for the reason of TACE discontinuation. UTP was defined according to the EASL guidelines, considering radiological pattern of progression, liver function and performance status (PS). Overall and post-progression survival (OS, PPS) for different reasons of TACE discontinuation were compared. The correlation between time to untreatable progression by chemoembolization (TTUPc) and OS was analyzed.

Results: One hundred and sixty-six patients (BCLC-A 40%, BCLC-B 54%, BCLC-C: 7%) were included, undergoing a median of 2 TACE procedures with a median OS of 22.1 months (95% CI 17.4-26.7). UTP occurred in 116 patients (70%) after a median TTUPc of 11.6 months (95% CI 7.8-15.4). There was a strong positive correlation (ρ = 0.816, p < 0.001) between TTUPc and OS. The main reason of UTP was radiological progression (61%), which was mostly intrahepatic (75%). Hepatic decompensation and worsening of PS were independent predictors of OS and PPS.

Conclusion: The majority of HCC patients treated with TACE have UTP due to intrahepatic tumor progression with preserved liver function and PS, making them potential candidates for subsequent liver-directed or systemic treatment. TTUPc may be a valuable surrogate endpoint for OS in patients treated with TACE.

Level Of Evidence: Level II, prognosis study.

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References

Lo C, Ngan H, Tso W, Liu C, Lam C, Poon R . Randomized controlled trial of transarterial lipiodol chemoembolization for unresectable hepatocellular carcinoma. Hepatology. 2002; 35(5):1164-71. DOI: 10.1053/jhep.2002.33156. View

Llovet J, Real M, Montana X, Planas R, Coll S, Aponte J . Arterial embolisation or chemoembolisation versus symptomatic treatment in patients with unresectable hepatocellular carcinoma: a randomised controlled trial. Lancet. 2002; 359(9319):1734-9. DOI: 10.1016/S0140-6736(02)08649-X. View

Camma C, Schepis F, Orlando A, Albanese M, Shahied L, Trevisani F . Transarterial chemoembolization for unresectable hepatocellular carcinoma: meta-analysis of randomized controlled trials. Radiology. 2002; 224(1):47-54. DOI: 10.1148/radiol.2241011262. View

Llovet J, Bruix J . Systematic review of randomized trials for unresectable hepatocellular carcinoma: Chemoembolization improves survival. Hepatology. 2003; 37(2):429-42. DOI: 10.1053/jhep.2003.50047. View

Llovet J, Ricci S, Mazzaferro V, Hilgard P, Gane E, Blanc J . Sorafenib in advanced hepatocellular carcinoma. N Engl J Med. 2008; 359(4):378-90. DOI: 10.1056/NEJMoa0708857. View

Lammer J, Malagari K, Vogl T, Pilleul F, Denys A, Watkinson A . Prospective randomized study of doxorubicin-eluting-bead embolization in the treatment of hepatocellular carcinoma: results of the PRECISION V study. Cardiovasc Intervent Radiol. 2009; 33(1):41-52. PMC: 2816794. DOI: 10.1007/s00270-009-9711-7. View

Raoul J, Sangro B, Forner A, Mazzaferro V, Piscaglia F, Bolondi L . Evolving strategies for the management of intermediate-stage hepatocellular carcinoma: available evidence and expert opinion on the use of transarterial chemoembolization. Cancer Treat Rev. 2010; 37(3):212-20. DOI: 10.1016/j.ctrv.2010.07.006. View

Bruix J, Reig M, Rimola J, Forner A, Burrel M, Vilana R . Clinical decision making and research in hepatocellular carcinoma: pivotal role of imaging techniques. Hepatology. 2011; 54(6):2238-44. DOI: 10.1002/hep.24670. View

Cheng A, Guan Z, Chen Z, Tsao C, Qin S, Kim J . Efficacy and safety of sorafenib in patients with advanced hepatocellular carcinoma according to baseline status: subset analyses of the phase III Sorafenib Asia-Pacific trial. Eur J Cancer. 2012; 48(10):1452-65. DOI: 10.1016/j.ejca.2011.12.006. View

10.

Burrel M, Reig M, Forner A, Barrufet M, Rodriguez de Lope C, Tremosini S . Survival of patients with hepatocellular carcinoma treated by transarterial chemoembolisation (TACE) using Drug Eluting Beads. Implications for clinical practice and trial design. J Hepatol. 2012; 56(6):1330-5. DOI: 10.1016/j.jhep.2012.01.008. View

11.

Bruix J, Raoul J, Sherman M, Mazzaferro V, Bolondi L, Craxi A . Efficacy and safety of sorafenib in patients with advanced hepatocellular carcinoma: subanalyses of a phase III trial. J Hepatol. 2012; 57(4):821-9. DOI: 10.1016/j.jhep.2012.06.014. View

12.

Garwood E, Fidelman N, Hoch S, Kerlan Jr R, Yao F . Morbidity and mortality following transarterial liver chemoembolization in patients with hepatocellular carcinoma and synthetic hepatic dysfunction. Liver Transpl. 2012; 19(2):164-73. DOI: 10.1002/lt.23552. View

13.

Park W, Chung Y, Kim J, Jin Y, Lee D, Shim J . Recurrences of hepatocellular carcinoma following complete remission by transarterial chemoembolization or radiofrequency therapy: Focused on the recurrence patterns. Hepatol Res. 2013; 43(12):1304-12. DOI: 10.1111/hepr.12083. View

14.

Reig M, Rimola J, Torres F, Darnell A, Rodriguez-Lope C, Forner A . Postprogression survival of patients with advanced hepatocellular carcinoma: rationale for second-line trial design. Hepatology. 2013; 58(6):2023-31. DOI: 10.1002/hep.26586. View

15.

Rou W, Lee B, Moon H, Lee E, Kim S, Lee H . Risk factors and therapeutic results of early local recurrence after transcatheter arterial chemoembolization. World J Gastroenterol. 2014; 20(22):6995-7004. PMC: 4051943. DOI: 10.3748/wjg.v20.i22.6995. View

16.

Raoul J, Gilabert M, Piana G . How to define transarterial chemoembolization failure or refractoriness: a European perspective. Liver Cancer. 2014; 3(2):119-24. PMC: 4057788. DOI: 10.1159/000343867. View

17.

Xie Z, Wang X, Peng Y, Zhu S, Ma L, Xiang B . Systematic review comparing the safety and efficacy of conventional and drug-eluting bead transarterial chemoembolization for inoperable hepatocellular carcinoma. Hepatol Res. 2014; 45(2):190-200. DOI: 10.1111/hepr.12450. View

18.

Kudo M, Matsui O, Izumi N, Kadoya M, Okusaka T, Miyayama S . Transarterial chemoembolization failure/refractoriness: JSH-LCSGJ criteria 2014 update. Oncology. 2014; 87 Suppl 1:22-31. DOI: 10.1159/000368142. View

19.

Bruix J, Reig M, Sherman M . Evidence-Based Diagnosis, Staging, and Treatment of Patients With Hepatocellular Carcinoma. Gastroenterology. 2016; 150(4):835-53. DOI: 10.1053/j.gastro.2015.12.041. View

20.

Bruix J, Qin S, Merle P, Granito A, Huang Y, Bodoky G . Regorafenib for patients with hepatocellular carcinoma who progressed on sorafenib treatment (RESORCE): a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet. 2016; 389(10064):56-66. DOI: 10.1016/S0140-6736(16)32453-9. View