Premium
Radiologic response to transcatheter hepatic arterial chemoembolization and clinical outcomes in patients with hepatocellular carcinoma
Author(s) -
Kim Chang Joon,
Kim Hong Joo,
Park Jung Ho,
Park Dong Il,
Cho Yong Kyun,
Sohn Chong Il,
Jeon Woo Kyu,
Kim Byung Ik,
Kim MinJi
Publication year - 2014
Publication title -
liver international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.873
H-Index - 110
eISSN - 1478-3231
pISSN - 1478-3223
DOI - 10.1111/liv.12270
Subject(s) - medicine , hepatocellular carcinoma , response evaluation criteria in solid tumors , transcatheter arterial chemoembolization , univariate analysis , proportional hazards model , gastroenterology , radiology , ascites , progressive disease , multivariate analysis , chemotherapy
Background & Aims The current study analysed the association between radiologic tumour response and survival times of patients with hepatocellular carcinoma ( HCC ) who were treated with transcatheter hepatic arterial chemoembolization ( TACE ). Methods Among 493 consecutive patients presenting to our institution between July 2002 and June 2010 with radiologically ( n = 398) or histologically ( n = 95) confirmed HCC, 368 patients who met inclusion criteria, underwent TACE and had confirmed survival data were retrospectively reviewed. The radiologic response was assessed using RECIST 1.1, EASL and mRECIST criteria at 1 month after the initial TACE. Results By univariate analysis, higher Child–Turcotte–Pugh (CTP) score, bilobar and multifocal distribution of tumours, larger tumour size (>5 cm), higher serum alpha‐foetoprotein (AFP) level (>200 ng/ml), no subsequent radiofrequency ablation, advanced ECOG, UNOS and BCLC staging, absence of complete necrosis and non‐responder (SD or PD) in RECIST 1.1, EASL and mRECIST response assessment were significantly associated with shorter overall survival times. By Cox proportional hazards model, advanced age, presence of ascites, higher MELD score, advanced BCLC staging, absence of complete necrosis and non‐responder by RECIST 1.1, EASL and mRECIST criteria were independent and significant prognosticators for overall survival times in patients with HCC who underwent TACE. By time‐dependent ROC curve analysis, mRECIST response criteria showed greatest accuracy in predicting survival (AUROC = 0.8676), followed by EASL (AUROC = 0.8471) and RECIST 1.1 (AUROC = 0.7986). Conclusion mRECIST and EASL criteria for assessing radiologic response 1 month after initial TACE more consistently predict the differences in overall survival between responders and non‐responders than conventional RECIST 1.1 criteria.