Post -TACE Hepatocellular Carcinoma Response Assessment by Modified RECIST and Short Term Post TACE Survival

Abstract

Background: Transarterial Chemoembolization(TACE) although not curative, can improve the overall survival of patients. Modified response evaluation criteria in solid tumors (mRECIST) is used for the evaluation of the treatment response in patients after TACE. Aims: To assess the post-TACE hepatocellular carcinoma(HCC) response by mRECIST criteria and the short term post-TACE survival. Methods: All patients underwent super selective TACE using epirubicin and mRECIST response was calculated using MRI. Factors were analyzed for the post-TACE response and survival. Results: Among 54 patients with HCC, 42 were analyzed. The mean age was 59.12 ± 8.74 years. Predominant etiology was NASH (31%) and alcohol (23.8%). 23 patients had complete response(CR), 8 patients had partial response(PR), 4 patients had stable disease(SD) and7 patients had progressive disease(PD) as per mRECIST criteria. Objective response(OR) is defined as patients achieving either CR or PR and poor response(PoR) as patients achieving either SD or PD. 73.8 % had an objective response and 26.2% had a poor response. HAP score(P=0.003) and CHILD stage(P=0.011) were the most important predictors of a favorable mRECIST response. 72.7% died during the study period. There was a significant survival difference among patients with (OR) (25.64 months) than patients with (PR) (13.10 months), P=0. 001. mRECIST response predicted survival among the patients but it was not an independent factor as per multivariate analysis (HR=1.08, P=0.02). The independent predictors for survival were post-TACE decompensation (B-1.43, P=0.03), ECOG performance status (B-1.41, P=0.010), and the number of malignant lesions for TACE (HR 2.20, P=0.017). Conclusion: Patients undergoing TACE for intermediate stage HCC has a significant survival advantage when they achieve an objective response as per mRECIST. Proper selection of patients for TACE is important for getting an objective response and for better short-term survival.