Time to Transcatheter Arterial Chemoembolization Refractoriness in Patients with Hepatocellular Carcinoma in Kinki Criteria Stages B1 and B2

Arizumi, Tadaaki; Minami, Tomohiro; Chishina, Hirokazu; Kono, Masashi; Takita, Masahiro; Yada, Norihisa; Hagiwara, Satoru; Minami, Yasunori; Ida, Hiroshi; Ueshima, Kazuomi; Kamata, Ken; Minaga, Kosuke; Komeda, Yoriaki; Takenaka, Mamoru; Sakurai, Toshiharu; Watanabe, Tomohiro; Nishida, Naoshi; Kudo, Masatoshi

doi:10.1159/000480208

Cited by 49 publications

(60 citation statements)

References 38 publications

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“…These results confirm the robustness of the concept of TACE refractoriness as defined by treatment guidelines. [6,7] In keeping with previous Japanese studies [19,20,22] we found a deterioration of liver function in patients that were refractory to TACE. However, the degree of deterioration was not significant in our study, possibly because TACE refractoriness was defined as progression after two sessions of TACE.…”

Section: Plos Onesupporting

confidence: 90%

Evaluation of transarterial chemoembolization refractoriness in patients with hepatocellular carcinoma

et al. 2020

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Background & aimIn clinical practice, transarterial chemoembolization (TACE) has been widely used for the treatment of hepatocellular carcinoma (HCC) beyond as well as within guideline recommendations. Here we aimed to verify whether two consecutive non-responses could be an optimal criterion for creating a rule to stop TACE being performed on these patients. MethodsThis study evaluated 200 patients with HCC beyond the Milan criteria, initially treated with TACE. TACE response was determined using the mRECIST criteria via dynamic CT or MRI. Median follow-up duration was 23.9 months. ResultsWithin the 200 patients analyzed, 183 (91.5%) were male, with a total median age of 59.8 years. The mean size of the largest tumor was 6.8 cm, with 80 (40.0%) patients with �4 tumors. After the first TACE procedure, complete response, partial response, stable disease, or progressive disease were observed in 48 (24.0%), 87 (43.5%), 59 (29.5%) and 6 (3.0%) of patients, respectively. 45 (22.5%) patients showed no objective response (OR) following two consecutive TACE sessions. Of these, 28 received a subsequent TACE, with a 10.7% OR rate. Patients without OR showed poorer survival when compared to patients who achieved OR after repeated TACE. Multivariable analysis showed that size of the largest tumor >5cm and high alpha-fetoprotein of >200 ng/mL were significant factors associated with failure of OR to two consecutive TACE sessions. ConclusionPatients showing no OR to two consecutive TACE sessions will present a poor OR to subsequent TACE procedures. Early transition to systemic therapy may be advocated in such cases. PLOS ONEPLOS ONE | https://doi.org/10.

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Section: Plos Onesupporting

confidence: 90%

Evaluation of transarterial chemoembolization refractoriness in patients with hepatocellular carcinoma

et al. 2020

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“…Hepatocellular carcinoma which is out of the up-to-7 criteria can be more aggressive than the 1 that is within. Arizumi et al [23] reported that TACE refractoriness occurred earlier in hepatocellular carcinomas that were out of the up-to-7 criteria than those within the up-to-7 criteria. Although the up-to-7 criteria were not useful for discriminating between TACE effectiveness Dig Dis 2018;36:385-394 DOI: 10.1159/000489488 and refractoriness, it would possibly be predictive of the TACE refractoriness if more patients were studied.…”

Section: Discussionmentioning

confidence: 99%

Impact of Insufficient Response with an Increase in Tumor Number in Predicting Transcatheter Arterial Chemoembolization Refractoriness for Hepatocellular Carcinoma

Furuta¹,

Moriguchi²,

Okuda³

et al. 2018

Dig Dis

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Aim: In Japan, transcatheter arterial chemoembolization (TACE) refractoriness for hepatocellular carcinoma has been defined as an insufficient therapeutic effect after ≥2 procedures. Insufficient TACE for intrahepatic lesions is defined as the presence of > 50% viable lesions (ineffective) or an increase in their number (progressive). This study aimed to examine the possibility of earlier evaluation of TACE refractoriness. Methods: Patients who underwent TACE for hepatocellular carcinomas > 3 cm in size or with > 3 nodules at our hospital between 2010 and 2014 were analyzed. The cases assessed as TACE insufficient for the first time were divided into 2 groups: the “either” group, evaluated as either “ineffective” or “progressive,” and the “both” group, that is, both “ineffective” and “progressive.” Results: The study participants included 40 of 212 consecutive patients who underwent TACE, divided into the either (n = 23) and both (n = 17) groups. Seventeen of 23 (73.9%) patients in the either group and all 17 (100%) in the both group had TACE refractoriness (p = 0.0295). Conclusions: Patients with both “ineffective” and “progressive” lesions are extremely likely to be TACE refractory at a significantly higher frequency than are those with either condition. Thus, when both of these factors are observed, switching to other therapies should be considered.

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“…The Japan Society of Hepatology tentatively defines TACE refractoriness based on the effect of two consecutive TACE procedures in reference to expert consensus, although the criteria for TACE refractoriness have not been definitively established in other countries . Several studies have assessed the definition of TACE refractoriness as adequate for clinical criteria . Factors, such as the viable tumor number and size targeted for TACE before the initial TACE procedure or during early TACE sessions, have been found to predict the probability of TACE refractoriness .…”

Section: Introductionmentioning

confidence: 99%

“…[1][2][3]8 Several studies have assessed the definition of TACE refractoriness as adequate for clinical criteria. 9,10 Factors, such as the viable tumor number and size targeted for TACE before the initial TACE procedure or during early TACE sessions, have been found to predict the probability of TACE refractoriness. [9][10][11][12] Nevertheless, no useful markers have been confirmed to predict TACE refractoriness.…”

Section: Introductionmentioning

confidence: 99%

Hypovascular hepatic nodules as a predictive factor for transcatheter arterial chemoembolization refractoriness in hepatocellular carcinoma

Maesaka

Sakamori

Yamada

et al. 2019

Hepatology Research

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Aim Intermediate‐stage hepatocellular carcinoma (HCC) targeted for transcatheter arterial chemoembolization (TACE) corresponds to a highly heterogeneous population for whom the factors predicting TACE efficacy have not been established. This study aimed to evaluate the impact of hypovascular hepatic nodules coexisting with intermediate‐stage HCC as a significant predictive factor for TACE refractoriness. Methods A total of 66 patients with intermediate‐stage HCC who received initial TACE were retrospectively analyzed. Hypovascular hepatic nodules were detected by dynamic computed tomography or magnetic resonance imaging, as well as angiography, before all initial TACE. The time to TACE refractoriness (TTTR) was defined as the period from initial TACE until the diagnosis of TACE refractoriness. Results Hypovascular hepatic nodules were detected in 36 patients (54.5%), 15 (41.7%) of whom had a single nodule, whereas 21 (58.3%) had multiple nodules, and the median size of the maximum nodule was 10 mm (range 5–80 mm). The median TTTR was 17.4 months for all patients, and 7.3 and 33.1 months for patients with and without hypovascular hepatic nodules, respectively. The TTTR was significantly shorter for patients with hypovascular hepatic nodules than that for the other patients. In the multivariate analysis, the presence of hypovascular hepatic nodules (HR 7.016, 95% CI 3.534–13.930; P < 0.001) and being out of the up‐to‐seven criteria (HR 2.861, 95% CI 1.493–5.486; P = 0.002) were independent risk factors for a short TTTR. Conclusions The presence of hypovascular hepatic nodules with intermediate‐stage HCC represents a significant predictive risk factor for TACE refractoriness.

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Time to Transcatheter Arterial Chemoembolization Refractoriness in Patients with Hepatocellular Carcinoma in Kinki Criteria Stages B1 and B2

Cited by 49 publications

References 38 publications

Evaluation of transarterial chemoembolization refractoriness in patients with hepatocellular carcinoma

Evaluation of transarterial chemoembolization refractoriness in patients with hepatocellular carcinoma

Impact of Insufficient Response with an Increase in Tumor Number in Predicting Transcatheter Arterial Chemoembolization Refractoriness for Hepatocellular Carcinoma

Hypovascular hepatic nodules as a predictive factor for transcatheter arterial chemoembolization refractoriness in hepatocellular carcinoma

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