Abstract
Finding a feeding vessel with diameter greater than 0.9 mm on transcatheter chemoembolization (TACE) angiogram for hepatocellular cancer (HCC) has been shown to predict tumor necrosis on subsequent pathology. However, whether this finding can translate into a useful clinical predictor for post-chemoembolization response and survival is unknown. This study aimed to determine whether the presence of an arterial feeder vessel on pre-TACE cross-sectional imaging predicts treatment response and survival after TACE for HCC. After IRB approval, retrospective med-rec search for all TACE procedures performed for HCC in 2016 yielded 71 patients that underwent 149 TACE sessions spanning 2013 to 2017. Patients consisted of 56 males (79%), mean age of 62 (r, 37-86), with each patient undergoing 1-5 TACE sessions. Endpoints included target lesion response and overall treatment response, as defined by the mRECIST criteria, as well as patient survival. Pre-procedural liver MRI was reviewed for presence of arterial feeder. Multilevel logistic regressions and Cox regressions were used to assess the effects of arterial feeder presence on treatment response and patient survival, respectively, adjusting for other covariates. Overall treatment response (complete and partial) was seen in 56% of TACE treatments in 69% of patients. Arterial feeder was present on preprocedural MRI in 36% of TACE sessions. The presence of arterial feeder on pre-TACE MRI led to better target lesion response (OR = 20.43, p = 0.0001) and overall treatment response (OR = 14.91, p<0.0001). Mean survival for all patients was 21.8 months (r, 1.3-54.8). Advanced age (HR = 1.05, p = 0.046) and increased tumor size (HR = 1.15, p = 0.002) were associated with reduced patient survival after TACE. The presence of arterial feeder also trended towards increased survival (HR = 0.41, p = 0.0696), although this relationship did not reach statistical significance. The presence of an arterial feeder on pre-TACE MRI predicts both target lesion response and overall treatment response after TACE. Further research to validate if presence of arterial feeder can be a non-invasive marker of tumor response and improved patient survival is warranted.
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