Comparison of radiologic response criteria as predictors for refractoriness and survival to transarterial chemoembolization among hepatocellular cancer: Outcomes from a Southeast Asian cohort

Abstract

Objectives: Radiologic response helps select patients with hepatocellular carcinoma who may become refractory after repeated sessions of transarterial chemoembolization (TACE). The utility of the various criteria in assessing radiologic response and survival is, however, poorly defined. This study aimed to compare the modified response evaluation criteria in solid tumors and Choi criteria as well as identify other predictors of overall survival and refractory disease of HCC patients undergoing repetitive TACE. Material and Methods: The radiologic response, as well as clinical and laboratory characteristics of 39 patients treated with repetitive conventional TACE from January 2012 to January 2019, were analyzed in a retrospective cohort. Results: The median overall survival of patients was 23.2 months and overall mortality was 36%. Multivariate Cox regression analysis revealed that progressive disease (PD) using Choi criteria (HR = 5.47, CI 1.15–25.99, P = 0.033) and enhancement on follow-up CT (computed tomography) imaging (HR = 1.98, P = 0.034) were independent risk factors for poor survival as were Child-Pugh score (Hazard ratio = 3.47, P = 0.044), AST (HR = 7.6, P = 0.021), tumor size (HR = 5.47, P = 0.033), and neutrophil-lymphocyte ratio (HR = 1.25, P = 0.049). Multivariate analysis also showed that ALT (P = 0.005), enhancement (P = 0.003), Child-Pugh score (P = 0.010), and PD using Choi criteria (P = 0.022) were predictive of TACE refractoriness/failure. Conclusion: Predictors for poorer survival and TACE failure/refractory disease were identified. Radiologic response using the Choi criteria and persistent contrast enhancement on radiologic follow-up is ominous imaging signs on patient surveillance and should be included in a rational treatment strategy and the decision to switch therapy.