Abstract
Aim: Transcatheter arterial chemoembolization (TACE) is thought to be a safe and effective treatment for hepatocellular carcinoma (HCC). However, in some HCC patients, it potentially shortens survival due to liver damage. We aimed to identify independent factors to predict overall survival of HCC after TACE. Methods: We included a total of 96 consecutive HCC patients who underwent TACE at Kobe University Hospital. Areas of skeletal muscle and fat tissue were measured by computed tomography (CT) scan before TACE. We divided the patients into two groups in terms of the presence or absence of 1-year mortality after TACE. Factors associated with 1-year mortality after TACE were assessed by multivariate analyses, and the optimal cut-off values were evaluated using a propensity score. Results: Multivariate analyses showed that visceral fat accumulation on CT was an independent factor associated with 1-year mortality after TACE (p = 0.033). There were no differences in skeletal muscle area and subcutaneous and intermuscular fat area between the two groups. Cut-off values for visceral fat area associated with 1-year mortality after TACE were defined as 33.3 cm2/m2 for males and 24.4 cm2/m2 for females. Conclusions: High visceral fat area was a prognostic factor associated with increased mortality rate in HCC patients undergoing TACE. Using this value, 1-year mortality risk after TACE would be better estimated before the day TACE was performed.
Highlights
Transcatheter arterial chemoembolization (TACE) is the most widely used first-line treatment in the western world and Asia for patients with unresectable hepatocellular carcinoma (HCC)
Factor Analyses Associated with 1-Year Mortality after TACE
Body mass index (BMI), Child’s score, Tumor Node Metastasis (TNM) stage, past treatment frequency of TACE, visceral fat area, C-reactive protein (CRP), ICG test retention rate at 15 min, alpha fetoprotein (AFP), and des-γ-carboxy prothrombin (DCP) were significantly higher in the 1-year mortality group than in the survival group (p = 0.002, 0.009, 0.001, 0.000, 0.016, 0.023, 0.005, 0.004, and 0.000, respectively)
Summary
Transcatheter arterial chemoembolization (TACE) is the most widely used first-line treatment in the western world and Asia for patients with unresectable hepatocellular carcinoma (HCC). TACE displays a tumor-response rate of 30% - 60% [1]-[3] and shows a survival benefit compared with that in controls [4]-[6]. TACE against HCC sometimes worsens liver parenchymal function. Current guidelines for HCC management recommend mortality risk estimates as a decision-making support [10]. Several staging systems before HCC treatment have been developed for mortality risk estimates. We previously reported that energy metabolism could be associated with overall survival in HCC patients after TACE [16]. Visceral fat can be measured by computed tomography (CT) scan [18], which is routinely used to screen for HCC lesions in cirrhotic patients, and provides precise, objective, and reproducible quantification of visceral fat mass
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