Local Recurrence of Hepatocellular Carcinoma after Segmental Transarterial Chemoembolization: Risk Estimates Based on Multiple Prognostic Factors

Abstract

ObjectiveTo determine the prognostic factors for local recurrence of nodular hepatocellular carcinoma after segmental transarterial chemoembolization.Materials and MethodsSeventy-four nodular hepatocellular carcinoma tumors ≤ 5 cm were retrospectively analyzed for local recurrence after segmental transarterial chemoembolization using follow-up CT images (median follow-up of 17 months, 4-77 months in range). The tumors were divided into four groups (IA, IB, IIA, and IIB) according to whether the one-month follow-up CT imaging, after segmental transarterial chemoembolization, showed homogeneous (Group I) or inhomogeneous (Group II) iodized oil accumulation, or whether the tumors were located within the liver segment (Group A) or in a segmental border zone (Group B). Comparison of tumor characteristics between Group IA and the other three groups was performed using the chi-square test. Local recurrence rates were compared among the groups using the Kaplan-Meier estimation and log rank test.ResultsLocal tumor recurrence occurred in 19 hepatocellular carcinoma tumors (25.7%). There were: 28, 18, 17, and 11 tumors in Group IA, IB, IIA, and IIB, respectively. One of 28 (3.6%) tumors in Group IA, and 18 of 46 (39.1%) tumors in the other three groups showed local recurrence. Comparisons between Group IA and the other three groups showed that the tumor characteristics were similar. One-, two-, and three-year estimated local recurrence rates in Group IA were 0%, 11.1%, and 11.1%, respectively. The difference between Group IA and the other three groups was statistically significant (p = 0.000).ConclusionAn acceptably low rate of local recurrence was observed for small or intermediate nodular tumors located within the liver segment with homogeneous iodized oil accumulation.

Feasibility and Techniques of Securing 3D-Safety Margin in Superselective Transarterial Chemoembolization to Improve Local Tumor Control for Small Hepatocellular Carcinoma: An Intend-to-Treat Analysis

“…In our results, the overall 1-year and 2-year local recurrence ratios were 8.3 and 16.7%, respectively. Our results were similar to those of Park et al [10] in the center of the liver segment. This could be due to obtaining 3D-safety margin in an adjacent area in cases with tumors located in a segmental or subsegmental border.…”

“…Previously, Park et al [10] reported that tumors located in the center of the liver segment showed lower recurrence ratio of 13.3% when compared with tumors located in a segmental border zone of 44.8% during the median follow-up period of 17 months. In our results, the overall 1-year and 2-year local recurrence ratios were 8.3 and 16.7%, respectively.…”

“…Other reports showed local recurrence occurred more frequently in cases with high serum alpha-fetoprotein level and tumors located at the segmental border zone of the liver. These are also tumor factors, which are not able to be controlled by TACE technique [9, 10].…”

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“…7,12 A study from Korea reported a higher rate of recurrence than our study (22.4%). 13 Currently, HCC is one of the major indications for OLT, with expected recurrence rates between 15% to 20% and less than 10% in patients who meet the Milan criteria, and overall survival rate of patients within Milan criteria is over than 70% after liver transplant. 10,14 In patients in our study, the tumorfree survival rate for tumors within Milan criteria was 83.9% and beyond Milan criteria was 69.2%.…”

The Current Practice of Transarterial Chemoembolization for the Treatment of Hepatocellular Carcinoma

“…There is increasing evidence that selective TACE achieves better antitumoral effects and reduces both the dosage of drugs used for TACE and the number of TACE sessions needed to achieve extensive tumor necrosis as compared to the use of conventional TACE (8-11). …”