Effects of Early TACE Refractoriness on Survival in Patients with Hepatocellular Carcinoma: A Real-World Study

Abstract

Purpose To investigate the effect of early transarterial chemoembolization (TACE) refractoriness on hepatocellular carcinoma (HCC) patient survival and to explore whether viable lesions > 50% after two consecutive TACE treatments negatively affect the prognosis of HCC patients. Patients and Methods From January 2014 to August 2017, 323 HCC patients who received TACE as the initial treatment were analyzed. TACE refractoriness was diagnosed according to the Japan Society of Hepatology 2021 version. Propensity score matching (PSM) was used to create a 1:1 matched group (nonrefractoriness vs refractoriness). To determine survival outcomes and prognostic factors, the Kaplan-Meier method and Cox proportional hazards model were used. Results In total, 51.1% of patients developed early TACE refractoriness (n = 165). After PSM, 120 patients from each group were matched and analyzed. The median overall survival (OS) time of the early TACE refractoriness group was significantly shorter than that of the nonrefractory group [21 months (95% CI: 15.7–26.3) vs 34 months (95% CI: 27.5–40.5), p = 0.002]. Thirty-eight patients with viable lesions >50% after two consecutive TACE procedures were identified and matched with patients of non-refractoriness. No significant difference in median OS was observed [35 months (95% CI: 21.6–48.5) vs 31 months (95% CI: 25.4–36.6), p = 0.611]. Multivariate analysis revealed that the BCLC stage, tumor size, tumor capsule, tumor distribution, α-fetoprotein level (AFP), and early TACE refractoriness were independent risk factors for prognosis in HCC patients. Conclusion Early TACE refractoriness may shorten the OS of HCC patients. However, viable lesions >50% after two consecutive TACE treatments did not impair the survival of patients. It may be inappropriate to consider these patients as having developed TACE refractoriness.

Transarterial Chemoembolization Combined with Atezolizumab Plus Bevacizumab or Lenvatinib for Unresectable Hepatocellular Carcinoma: A Propensity Score Matched Study

“…By controlling the intrahepatic tumor burden, there is a potential to improve liver function, PFS, and allow for a longer duration of systemic therapy, ultimately enhancing the effectiveness of overall treatment. 8 , 26 As research on anti-VEGF drug and immune checkpoint inhibitors deepens, the rationality of TACE-based combination therapy is gradually being accepted. Firstly, after TACE treatment, tumor cells induce upregulation of HIF-1α in the hypoxic environment, leading to upregulation of VEGF and platelet-derived growth factor (PDGF) expression.…”

Outcomes of transarterial chemoembolization in patients with unresectable hepatocellular carcinoma: A tertiary center experience

“…In a study by Yang et al, the median overall survival in TACE responsive HCC was 34 months following TACE, whereas it was 21 months in non-responsive tumors. 10 Another study showed the median survival time to be 37 months following first session of TACE. 11 Trans-arterial radioembolisation (TARE) is a further advancement in TACE which is gaining popularity.…”

The Role of GNMT and MMP12 Expression in Determining TACE Efficacy: Validation at Transcription and Protein Levels

“… 11 However, there is still no consensus on this concept in the international community, and TACE refractoriness does not fully represent the poor prognosis. 12 More importantly, the above criteria cannot reliably reflect the long-term prognosis of patients directly and cannot accurately stratify patients before treatment. Although studies have used clinical information or extracted imaging features to develop a model to predict the efficacy of TACE.…”