Chemoembolization for Single Large Hepatocellular Carcinoma with Preserved Liver Function: Analysis of Factors Predicting Clinical Outcomes in a 302 Patient Cohort.

Gun Ha Kim,Heung-Kyu Ko,Gi-Young Ko,Dong Il Gwon,Hyun-Ki Yoon,Jin Hyoung Kim,Ji Hoon Shin,Hee Ho Chu,Ju Hyun Shim

doi:10.3390/life11080840

Gun Ha Kim, Heung-Kyu Ko + Show 7 more

Open Access

https://doi.org/10.3390/life11080840

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Journal: Life	Publication Date: Aug 17, 2021
Citations: 10	License type: CC BY 4.0

Affiliation: University of Ulsan, Asan Medical Center, Ulsan College

Abstract

The purpose of this study was to define the role of transcatheter arterial chemoembolization (TACE) in patients with a single large hepatocellular carcinoma (HCC) and define the patient groups benefiting from TACE. Treatment-naïve patients with preserved liver function who received TACE as the first-line treatment for single large (>5 cm) HCC without macrovascular invasion and extrahepatic metastasis between 2007 and 2019 were retrospectively analyzed. Overall survival, progression-free survival, radiologic tumor response, complications, and predictors of survival were analyzed using multivariate analysis, and then a pretreatment risk-prediction model was created using the four predictive factors of tumor size, tumor type, ALBI grade, and ECOG performance status. Patients with scores of 0 (n = 54), 1–2 (n = 170), and 3–6 (n = 78) according to the model were classified as low-, intermediate-, and high-risk, respectively. The corresponding median OS values were 141, 55, and 28 months, respectively. The percentage of major complications increased as tumor size increased (4–21%). Asymptomatic, nodular HCC patients with a tumor size of 5–7 cm and ALBI grade 1 benefited the most from TACE. By contrast, the value of TACE in the treatment of single huge HCC (>10 cm) with high complication rates remains unclear.

Highlights

According to the updated Barcelona Clinic Liver Cancer (BCLC) staging system [1], single large (>5 cm) hepatocellular carcinoma (HCC) is classified as early-stage disease (BCLC A) because of higher survival when treated with surgical resection in comparison with alternative treatments [2,3]
Transcatheter arterial chemoembolization (TACE) is a treatment that has been widely used for many years to delay tumor progression in patients with unresectable HCC [6]
Rates of tumor-related symptoms (ECOG performance status of 1) and serum AFP ≥ 400 ng/mL were higher in tumors of larger size

Summary

Introduction

According to the updated Barcelona Clinic Liver Cancer (BCLC) staging system [1], single large (>5 cm) hepatocellular carcinoma (HCC) is classified as early-stage disease (BCLC A) because of higher survival when treated with surgical resection in comparison with alternative treatments [2,3]. Surgical resection is not always suitable for single large HCC, which is not infrequently considered unresectable because of the tumor size, location, patient age, underlying liver cirrhosis, or other comorbidities [4,5]. Major liver resection is typically required to treat large HCC, and some patients are reluctant to receive aggressive surgical resection. Asymptomatic patients with multinodular HCCs and those with unresectable single large HCCs with preserved liver function are considered to be “recommended” or “ideal” TACE candidates [4,7]

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