Best Response during Repeated Chemoembolization Is the Most Significant Predictor of Survival in Hepatocellular Carcinoma

Objectives: Whether initial or best response is the better predictor of overall survival after transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC) remains controversial. We retrospectively evaluated the clinical implications of initial and best responses during repeated TACE for HCC. Methods: This study included adult patients who received a diagnosis of intermediate-stage HCC with preserved liver function between 2007 and 2016 and who were treated with TACE as the first-line treatment. Evaluation of the treatment response was based on the modified Response Evaluation Criteria in Solid Tumors. Results: Of the 726 included patients, an objective response (complete response [CR] or partial response [PR]) was observed as the initial response in 78.1% of the patients. Regarding the best response during the TACE series, 87.2% of the patients were overall responders. Overall survival was similar between initial responders (n = 567) and subsequent responders (n = 66; 43.8 vs. 40.1 months, P = 0.433). Likewise, overall survival was similar between initial CR (n = 366) and subsequent CR (n = 144) groups (52 vs. 46 months, P = 0.527). Multivariable Cox analyses showed that the most significant independent prognostic factor predicting overall survival was an objective response as the best response. The adjusted hazard ratio of the responders as the best response (0.216) was lower than that of the responders as the initial response (0.493). Conclusion: The best response observed during serial TACE, rather than the initial response, most strongly predicted overall survival in patients with intermediate-stage HCC and preserved liver function.

Publication History

Article published online:
26 April 2021