Cost-Effectiveness of Tumor Response Criteria After Chemoembolization for Hepatocellular Carcinoma: Working Harder May Be Worth It.

Abstract

Hepatocellular carcinoma (HCC) is the most common primary liver cancer and remains a leading cause of cancer-related mortality. Transarterial chemoembolization (TACE) improves survival among patients with HCC [ 1 Llovet J.M. Real M.I. Montaña X. et al. Arterial embolisation or chemoembolisation versus symptomatic treatment in patients with unresectable hepatocellular carcinoma: a randomised controlled trial. Lancet. 2002; 359: 1734-1739 Abstract Full Text Full Text PDF PubMed Scopus (2719) Google Scholar ] and is the recommended first-line treatment for patients with intermediate-stage disease according to the Barcelona Clinic Liver Cancer (BCLC) system. As such, it remains the most widely used liver-directed therapy. However, a single TACE treatment infrequently yields complete response in such patients with multiple or large masses. A recent meta-analysis of 101 clinical studies including 10,108 subjects receiving TACE revealed a combined complete and partial response rate of 52.5% [ 2 Lencioni R. Baere T de Soulen M.C. Rilling W.S. Geschwind J.-F.H. Lipiodol transarterial chemoembolization for hepatocellular carcinoma: a systematic review of efficacy and safety data. Hepatology. 2016; 64: 106-116 Crossref PubMed Scopus (271) Google Scholar ]. Timely and accurate identification of residual disease after TACE is therefore critical to guide retreatment and prolong patient survival. Multiple imaging criteria have been developed over the past two decades for systematic assessment of treatment efficacy. In this issue, Malhotra et al [ 3 Wu X. Chapiro J. Malhotra A. Cost-effectiveness of imaging tumor response criteria in hepatocellular cancer after transarterial chemoembolization. J Am Coll Radiol. 2021; 18: 927-934 Abstract Full Text Full Text PDF Scopus (2) Google Scholar ] report the results of a decision analytic model comparing the incremental cost-effectiveness of three tumor response criteria—Response Evaluation Criteria in Solid Tumors (RECIST), modified RECIST (mRECIST), and quantitative European Association for Study of the Liver (qEASL)—for assessment of treatment response after TACE for intermediate-stage HCC. Cost-Effectiveness of Imaging Tumor Response Criteria in Hepatocellular Cancer After Transarterial ChemoembolizationJournal of the American College of RadiologyVol. 18Issue 7PreviewSeveral tumor response criteria on cross-sectional imaging have been used in hepatocellular cancer after locoregional, intra-arterial therapy. The cost implications of their efficacy and accuracy are not well established. Full-Text PDF