Ya-Ju Tsai1,2,3, Chia-Yang Hsu4,5,6, Yi-Hsiang Huang7, Chien-Wei Su4,5, Han-Chieh Lin4,5, Rheun-Chuan Lee4,8, Jen-Huey Chiang4,8, Teh-Ia Huo9,10, Shou-Dong Lee4,5. 1. School of Nursing, National Yang-Ming University, Taipei, Taiwan. 2. Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan. 3. School of Nursing, University of Michigan, Ann Arbor, MI, USA. 4. Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan. 5. Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan. 6. Department of Medicine, National Yang-Ming University Hospital, Yilan, Taiwan. 7. Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan. 8. Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan. 9. Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan. tihuo@vghtpe.gov.tw. 10. Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan. tihuo@vghtpe.gov.tw.
Abstract
PURPOSE: Transarterial chemoembolization (TACE) is used to treat unresectable hepatocellular carcinoma (HCC). However, HCC patients may have an even shorter survival after TACE. This study aimed to identify poor responders to TACE at an early stage. PATIENTS AND METHODS: A total of 624 and 122 patients with HCC undergoing TACE and best supportive care (BSC), respectively, were analyzed. Poor responders were defined as patients who died after TACE or had viable tumor(s), but not eligible for further treatment at 3 months of treatment. RESULTS: A total of 102 (16%) patients were identified as poor responders. Poor responders had a significantly decreased long-term survival than other patients receiving TACE and a tendency of higher risk of mortality than patients receiving BSC (p < 0.001 and p = 0.054, respectively). The comparison of 24-month survival showed significantly worse outcome in poor responders than patients receiving BSC (p = 0.04). Serum α-fetoprotein (AFP) level >40 ng/mL (p = 0.024) and albumin level 3.8 g/dL (p = 0.016), Child-Turcotte-Pugh (CTP) class B (p = 0.011), performance status 1 (p < 0.001), total tumor volume (TTV) >65 cm(3) (p = 0.001), and vascular invasion (p = 0.005) were independent risk factors predicting poor response at 3 months in the multivariate logistic regression analysis. Among the four HCC staging systems, the Barcelona Clinic Liver Cancer (BCLC) classification showed the highest predictive accuracy for the identification of poor responders. CONCLUSIONS: Poor responders have an increased risk of mortality due to rapid disease progression after TACE. Advanced BCLC stages may better predict a poor response to TACE.
PURPOSE: Transarterial chemoembolization (TACE) is used to treat unresectable hepatocellular carcinoma (HCC). However, HCC patients may have an even shorter survival after TACE. This study aimed to identify poor responders to TACE at an early stage. PATIENTS AND METHODS: A total of 624 and 122 patients with HCC undergoing TACE and best supportive care (BSC), respectively, were analyzed. Poor responders were defined as patients who died after TACE or had viable tumor(s), but not eligible for further treatment at 3 months of treatment. RESULTS: A total of 102 (16%) patients were identified as poor responders. Poor responders had a significantly decreased long-term survival than other patients receiving TACE and a tendency of higher risk of mortality than patients receiving BSC (p < 0.001 and p = 0.054, respectively). The comparison of 24-month survival showed significantly worse outcome in poor responders than patients receiving BSC (p = 0.04). Serum α-fetoprotein (AFP) level >40 ng/mL (p = 0.024) and albumin level 3.8 g/dL (p = 0.016), Child-Turcotte-Pugh (CTP) class B (p = 0.011), performance status 1 (p < 0.001), total tumor volume (TTV) >65 cm(3) (p = 0.001), and vascular invasion (p = 0.005) were independent risk factors predicting poor response at 3 months in the multivariate logistic regression analysis. Among the four HCC staging systems, the Barcelona Clinic Liver Cancer (BCLC) classification showed the highest predictive accuracy for the identification of poor responders. CONCLUSIONS: Poor responders have an increased risk of mortality due to rapid disease progression after TACE. Advanced BCLC stages may better predict a poor response to TACE.
Entities:
Keywords:
Barcelona Clinic Liver Cancer (BCLC); Best supportive care; Hepatocellular carcinoma; Total tumor volume; Transarterial chemoembolization
Authors: C Cammà; V Di Marco; G Cabibbo; F Latteri; L Sandonato; P Parisi; M Enea; M Attanasio; M Galia; N Alessi; A Licata; M A Latteri; A Craxì Journal: Aliment Pharmacol Ther Date: 2008-03-27 Impact factor: 8.171
Authors: Christian Toso; James Trotter; Alice Wei; David L Bigam; Shimul Shah; Joshua Lancaster; David R Grant; Paul D Greig; A M James Shapiro; Norman M Kneteman Journal: Liver Transpl Date: 2008-08 Impact factor: 5.799
Authors: Rebecca M Dodson; Amin Firoozmand; Omar Hyder; Vania Tacher; David P Cosgrove; Nikhil Bhagat; Joseph M Herman; Christopher L Wolfgang; Jean-Francois H Geschwind; Ihab R Kamel; Timothy M Pawlik Journal: J Gastrointest Surg Date: 2013-09-25 Impact factor: 3.452