Predictive Factors of Tumor Recurrence and Survival in Patients with Hepatocellular Carcinoma treated with Transarterial Chemoembolization

Abstract

Background & Aims: To evaluate the predictive factors for recurrence of the disease and overall survival(OS) after achieving complete response (CR) in patients with hepatocellular carcinoma (HCC) treated withtransarterial chemoembolization (TACE).Methods: From January 2013 to December 2017, 168 treatment-naïve patients diagnosed with HCCunderwent TACE as a first-line therapy and the gathered data was retrospectively reviewed. We determined the predictive factors for complete response (CR), for recurrence after CR and for survival using the Cox proportional hazard model.Results: Median follow-up was 27.4 months (range 4-65 months). The mean patient age was 62.2±7.9 years. Eighty-three patients had an α-fetoprotein (AFP) level > 20ng/mL. The median maximal diameter of the tumors was 3.5 cm. Sixty-three patients (37.5%) achieved CR after TACE, and recurrence after CR was detected in 37 patients (58.7%). In multivariate analysis, tumor size (≤4.5 cm) and a single tumor were found to be predictive factors for CR, with hazard ratios (HRs) of 2.352 (p=0.022) and 3.964 (p<0.0001), respectively. After achieving CR the median time to recurrence was 12 months (range 6-24 months). Elevated serum AFP > 25 ng/mL and multiple tumors were demonstrated to have a significant relationship with recurrence after CR, with HRs of 1.650 (p=0.05) and 3.932 (p=0.038), respectively. Increased initial serum AFP > 22 ng/mL, tumorsize > 4.5 cm, outside Milan criteria, not receiving a liver transplant and presence of portal vein thrombosis (PVT) were correlated with poor survival.Conclusions: In patients treated with TACE as an initial therapy, tumor size (≤4.5 cm) and single tumor were predictive factors for CR. Multiple nodules and an elevated serum AFP > 25 ng/mL were predictive factors for recurrence after CR. Outside Milan criteria tumors, elevated AFP levels and the presence of PVT were significantly correlated with decreased survival.

Efficacy and Safety of the Combination of Pravastatin and Sorafenib for the Treatment of Advanced Hepatocellular Carcinoma (ESTAHEP Clinical Trial)

“…Thus, our study showed a decrease in OS associated to both parameters, which was independent of the assigned treatment. These data are in agreement with several retrospective studies that have reported this relationship [32,33] and with a recent study indicating that the presence of PVT is a predictive factor of poor survival in HCC [34].…”

Biology and significance of alpha‐fetoprotein in hepatocellular carcinoma

“…In the nonsurgical setting, pre‐intervention AFP levels have been shown to predict survival prognosis with locoregional therapies as well as with sorafenib, lenvatinib, regorafenib, cabozantinib and ramucirumab . Two studies evaluating radiofrequency ablation (RFA) for first‐line treatment of HCC in patients with Child‐Pugh A/B cirrhosis demonstrated 5‐year OS rates of 68% to 76% .…”

Neutrophil-to-lymphocyte ratio as a prognostic biomarker in hepatocellular carcinoma after transarterial chemoembolization

“…Transarterial chemoembolization (TACE) is considered for intermediate-stage HCC that is not eligible for curative treatment options (1,2). Tumor size, number of tumors, α-fetoprotein (AFP) level, Child-Turcotte-Pugh score, vascular invasion and tumor response have been identified as significant factors predicting overall survival (OS) in HCC patients treated with TACE (3)(4)(5)(6). However, the identification of robust prognostic markers is required for the precise prediction of response to TACE in HCC patients.…”