Beom Kyung Kim1, Seung Up Kim2, Kyung Ah Kim3, Yong Eun Chung4, Myeong-Jin Kim4, Mi-Suk Park4, Jun Yong Park1, Do Young Kim1, Sang Hoon Ahn5, Man Deuk Kim4, Sung Il Park4, Jong Yoon Won4, Do Yun Lee4, Kwang-Hyub Han5. 1. Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea; Yonsei Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Republic of Korea. 2. Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea; Yonsei Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Republic of Korea. Electronic address: ksukorea@yuhs.ac. 3. Department of Radiology, St. Vincent's Hospital, The Catholic University of Korea, Gyeonggi-do, Republic of Korea. 4. Department of Radiology, Yonsei University College of Medicine, Seoul, Republic of Korea. 5. Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea; Yonsei Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Republic of Korea; Brain Korea 21 Project for Medical Science, Seoul, Republic of Korea.
Abstract
BACKGROUNDS & AIMS: The aim of this study is to evaluate the prognostic significances of not only the initial and the best response during repeated transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC), but if eligible, also the time point of achieving treatment responses. METHODS: Three hundred and fourteen treatment-naïve patients with well-preserved liver function undergoing TACE were recruited. Treatment responses were assessed using modified Response Evaluation Criteria in Solid Tumors. Overall survival (OS) was analyzed using Kaplan-Meier methods, and Cox regression analysis was performed for multivariate analysis. RESULTS: After adjusting other variables, objective response (complete response [CR] and partial response [PR]) as the initial response (adjusted hazard ratio [HR] 0.410) and the best response (adjusted HR 0.335) had independent prognostic significances for OS, respectively (both p < 0.001). Objective responders as the initial response had the longest OS, followed by patients who subsequently achieved objective response after at least two sessions and those who did not achieve objective response during treatment course eventually (52.6, 27.0, and 10.8 months, respectively; log-rank test, p < 0.001). Likewise, patients with CR as the initial response had the longest OS, followed by those who subsequently achieved CR after at least two sessions and those who achieved PR as the best response (70.2, 40.6, and 23.0 months, respectively; log-rank test, p < 0.001). Large (>5 cm) and multiple (⩾ 4) tumors were independently associated with failure to achieve CR after the initial TACE (both p < 0.05). CONCLUSION: Both the initial and the best response predicts OS effectively. However, achievement of treatment response at an early time point is still the most robust predictor for favorable outcomes.
BACKGROUNDS & AIMS: The aim of this study is to evaluate the prognostic significances of not only the initial and the best response during repeated transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC), but if eligible, also the time point of achieving treatment responses. METHODS: Three hundred and fourteen treatment-naïve patients with well-preserved liver function undergoing TACE were recruited. Treatment responses were assessed using modified Response Evaluation Criteria in Solid Tumors. Overall survival (OS) was analyzed using Kaplan-Meier methods, and Cox regression analysis was performed for multivariate analysis. RESULTS: After adjusting other variables, objective response (complete response [CR] and partial response [PR]) as the initial response (adjusted hazard ratio [HR] 0.410) and the best response (adjusted HR 0.335) had independent prognostic significances for OS, respectively (both p < 0.001). Objective responders as the initial response had the longest OS, followed by patients who subsequently achieved objective response after at least two sessions and those who did not achieve objective response during treatment course eventually (52.6, 27.0, and 10.8 months, respectively; log-rank test, p < 0.001). Likewise, patients with CR as the initial response had the longest OS, followed by those who subsequently achieved CR after at least two sessions and those who achieved PR as the best response (70.2, 40.6, and 23.0 months, respectively; log-rank test, p < 0.001). Large (>5 cm) and multiple (⩾ 4) tumors were independently associated with failure to achieve CR after the initial TACE (both p < 0.05). CONCLUSION: Both the initial and the best response predicts OS effectively. However, achievement of treatment response at an early time point is still the most robust predictor for favorable outcomes.
Authors: Hyungjin Rhee; Ji Hae Nahm; Haeryoung Kim; Gi Hong Choi; Jeong Eun Yoo; Hye Sun Lee; Myoung Ju Koh; Young Nyun Park Journal: Mod Pathol Date: 2016-06-17 Impact factor: 7.842