Abstract
Background/AimsIt is important to identify patients who are refractory to transarterial chemoembolization (TACE), which is performed for the treatment of hepatocellular carcinoma (HCC). We investigated the predictors of poor treatment outcomes in patients with recurrent HCC treated who were treated with TACE after curative resection.Methods428 patients with recurrent HCC after curative resection who were treated with TACE were enrolled.ResultsThe median age of the study population was 59.2 years. On multivariate analysis, ≥2 TACE procedures within 6 months (hazard ratio [HR] = 1.898), and the des-gamma carboxyprothrombin level (HR = 1.000) independently predicted the progression to Barcelona Clinic Liver Cancer (BCLC) stage C in patients with BCLC stage 0-B HCC (both P<0.05). In addition, ≥2 and ≥3 TACE procedures within 6 months independently predicted mortality in the entire study population (HR = 1.863 and 1.620, respectively). The probability of progression to BCLC stage C in patients with BCLC stage 0-B HCC and the mortality rate in the entire study population were significantly higher in patients treated with ≥2 TACE within 6 months than in those who underwent fewer procedures (P = 0.002 and P<0.001, respectively).ConclusionsMore than 2 TACE procedures within 6 months might be associated with the refractoriness to TACE in patients with recurrent HCC after curative resection.
Highlights
Hepatocellular carcinoma (HCC) is ranked as the 5th most common cancer worldwide, and the 3rd leading cause of death [1, 2]
More than 2 transarterial chemoembolization (TACE) procedures within 6 months might be associated with the refractoriness to TACE in patients with recurrent HCC after curative resection
Ultrasound-based surveillance for HCC is applicable in clinical practice, HCC is still diagnosed in the late stage in a significant proportion of patients, for which only palliative treatments such as transarterial chemoembolization (TACE), targeted systemic or hepatic arterial infusion chemotherapies are available
Summary
Hepatocellular carcinoma (HCC) is ranked as the 5th most common cancer worldwide, and the 3rd leading cause of death [1, 2]. If HCC is detected in the early stage, several treatment options such as liver transplantation, surgical resection, or ablative therapy can be attempted with a curative intents [3]. Hepatic resection has been considered the mainstay of curative treatment for HCC, and offers a significantly better survival [4,5,6]. In contrast to the ultrasound-based surveillance of patients without HCC, the intensive follow-up strategy with dynamic imaging modalities, such as computed tomography (CT) or magnetic resonance imaging (MRI) after HCC resection has increased the possibility of detecting HCC recurrence at the early stage. TACE has been frequently performed to control recurrent HCC after resection, if there is no evidence of extra-hepatic metastasis or vessel invasion [9,10,11]
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