Chemoembolization for Single Large Hepatocellular Carcinoma with Preserved Liver Function: Analysis of Factors Predicting Clinical Outcomes in a 302 Patient Cohort

Abstract

The purpose of this study was to define the role of transcatheter arterial chemoembolization (TACE) in patients with a single large hepatocellular carcinoma (HCC) and define the patient groups benefiting from TACE. Treatment-naïve patients with preserved liver function who received TACE as the first-line treatment for single large (> 5 cm) HCC without macrovascular invasion and extrahepatic metastasis between 2007 and 2019 were retrospectively analyzed. Overall survival, progression-free survival, radiologic tumor response, complications, and predictors of survival were analyzed using multivariate analysis, and then a pretreatment risk-prediction model was created using the four predictive factors of tumor size, tumor type, ALBI grade, and ECOG performance status. Patients with scores of 0 (n = 54), 1–2 (n = 170), and 3–6 (n = 78) according to the model were classified as low-, intermediate-, and high-risk, respectively. The corresponding median OS values were 141, 55, and 28 months, respectively. The percentage of major complications increased as tumor size increased (4–21%). Asymptomatic, nodular HCC patients with a tumor size of 5–7 cm and ALBI grade 1 benefited the most from TACE. By contrast, the value of TACE in the treatment of single huge HCC (> 10 cm) with high complication rates remains unclear.

Efficacy and Safety of Transarterial Chemoembolization with a Three-Stage Mixed Chemoembolic Regimen for Large Unresectable Hepatocellular Carcinoma

“…In a cohort of 302 patients, Kim et al concluded that the efficacy of TACE in treating a single large HCC (>10 cm) remains uncertain. 30 Due to compromised liver function, these patients typically exhibited a relatively high rate of major complications (21%). 30 Similarly, according to the EASL guidelines, large HCC (>10 cm) is considered a relative contraindication for TACE.…”

“… 30 Due to compromised liver function, these patients typically exhibited a relatively high rate of major complications (21%). 30 Similarly, according to the EASL guidelines, large HCC (>10 cm) is considered a relative contraindication for TACE. 31 Nevertheless, we found that the large HCC (>10 cm) was not a significant prognostic factor for survival after TACE.…”

Efficacy and Safety of Combined Ethanol-Lipiodol Mixture and Drug-Eluting Bead TACE for Large HCC

“…In a 302 patient cohort, Kim et al concluded that the use of TACE for the treatment of single huge HCC (>10 cm) remains questionable. 28 Another study on 821 BCLC B patients treated with TACE, Kim et al proposed a new subclassification pushing the tumoral limits to the up to 11 criteria. 29 According to the survival results of the new B3 class (median survival 11.3 months), TACE is not recommended in this new class.…”

Transarterial chemoembolization for advanced hepatocellular carcinoma without macrovascular invasion or extrahepatic metastasis: analysis of factors prognostic of clinical outcomes

“…In the present study, evaluation of safety profiles showed that only large tumor size (>10 cm) was significantly associated with the occurrence of major complications, with a relatively high rate (21/98; 21%). TACE has been considered a relative contraindication for the treatment of huge HCC (> 10 cm) due to the increased risk of peri-procedural adverse effects and the suboptimal treatment response ( 33 , 34 ), and recent studies reported that hepatic arterial infusion chemotherapy (HAIC) was found to prolong OS compared with TACE in patients with huge HCC ( 35 – 37 ). A recent randomized phase III trial showed that the use of combinations of chemotherapy fluorouracil/leucovorin/oxaliplatin in HAIC group had a better OS (HR 0.57 [95% CI, 0.44 to 0.74]; P <.001) and a lower incidence of serious adverse events (19% vs. 30%, P = .03) compared with the TACE group for patients with large unresectable HCC without vascular invasion or extrahepatic metastasis ( 38 ).…”