Risk factors of extra-hepatic progression after transarterial chemoembolization for hepatocellular carcinoma patients: a retrospective study in 654 cases

Abstract

Aim: To investigate the risk factors of extra-hepatic progression after TACE in HCC.Methods: The study population included 654 HCC patients who underwent TACE between October 2005 and September 2012. We collected and analyzed their clinical characteristics and survival information. TACE was performed as previously described with minor modifications. When necessary, superselective chemoembolization was performed through the segmental or subsegmental arteries, based on the tumor location and extent and hepatic function reserve. If stasis could not be achieved in a tumor-feeding artery, iodized oil was used solely in some patients. Embolization was then performed with injection of absorbable gelfoam particles (1-2 mm in diameter) through the angiographic catheter.Results: The tumor response to initial TACE was evaluated in 645 patients. The CR rate, response rate (RR), and disease control rate (DCR) were 9.92%, 25.89%, and 70.39%, respectively. The median overall survival (OS) period was 14.5 months. The 6-month, 1-, 2-, 3-, and 5-year OS rates were 75.5%, 55.0%, 33.9%, 22.8%, and 14.9%, respectively. The median progression-free survival (PFS) period was 4.3 months. The 6-month, 1-, 2-, 3-, and 5-year PFS rates were 40.7%, 27.1%, 16.7%, 13.9%, and 9.3%, respectively. One hundred and fifty patients developed extrahepatic progression during follow-up. We demonstrated that in the absence of radical treatment after initial TACE (p<0.001), the presence of extrahepatic metastasis before initial TACE (p<0.001), AST >45 U/L (p=0.024), ALB <35 g/L (p=0.012), and tumor response were evaluated as PD and SD after initial TACE (p<0.001) and were found to be independent predictors of a poorer prognosis of extrahepatic PFS.Conclusions: We identified risk factors for extrahepatic progression after TACE in HCC patients. Early combination treatment was strongly recommended in patients that met these risk factors.

Development and Validation of a Prediction Model for Hepatitis B Virus-Related Hepatocellular Carcinoma Patients Receiving Postoperative Adjuvant Transarterial Chemoembolization

“…The survival rate of HCC patients after hepatectomy is mainly related to tumor characteristics and ALB levels. 35 For TACE therapy, abnormal ALB level is a potential prognostic factor for HCC patients after conventional TACE. 36 Li et al found that HCC patients who had ALB levels ≤ 35 g/L were at risk for extrahepatic progression following TACE, and early combination treatment was strongly advised for them.…”

“…36 Li et al found that HCC patients who had ALB levels ≤ 35 g/L were at risk for extrahepatic progression following TACE, and early combination treatment was strongly advised for them. 35 Besides, In Chinese HCC patients, CalliSpheres DEB-TACE has been proven effective and well-tolerated, and ALB level abnormality is independently associated with poor prognosis. 37,38 A critical tumor characteristic is macrovascular invasion, which includes invasion of the portal vein, hepatic vein, and inferior vena cava.…”

Prognostic value of serum uric acid and tumor response to induction chemotherapy in locally advanced nasopharyngeal carcinoma

“…Moreover, the tumor response to IC was identified to be an independent prognostic factor for OS, PFS, and DMFS, respectively. To our knowledge, the prognostic significance of tumor response to chemotherapy in various malignancies has been confirmed [ 22 , 23 ]. Subsequently, the tumor response to IC was demonstrated to be an independent prognostic factor for LANPC patients with IMRT [ 7 , 8 ], which was similar to our results.…”

Clinical Value of Serum LHPP-associated miR-765 in the Prognosis of Laparoscopic or Open Hepatectomy for Hepatocellular Carcinoma

“…The 5-year survival rate can reach 60% to 70%. 4 However, as most patients are in the advanced stage at the time of diagnosis, even after surgical resection or transplantation, the recurrence rate at 5 years is as high as 70% to 80%, and the 5-year survival rate is only 0% to 14%. 5 …”