Victoria Susanne Antonia Habbel1,2, Martin Zeile3, Gregor Alexander Stavrou4,5, Frank Wacker6, Roland Brüning7, Karl-Jürgen Oldhafer8,4, Thomas Rodt6,9. 1. Department of General and Visceral Surgery and Surgical Oncology, Asklepios Klinik Barmbek, Rübenkamp 220, 22307, Hamburg, Germany. v.habbel@asklepios.com. 2. Semmelweis Medical Faculty, Asklepios Campus Hamburg, Lohmühlenstraße 5, 20099, Hamburg, Germany. v.habbel@asklepios.com. 3. Department of Diagnostic and Interventional Radiology, Marienkrankenhaus GmbH, Alfredstraße 9, 22087, Hamburg, Germany. 4. Semmelweis Medical Faculty, Asklepios Campus Hamburg, Lohmühlenstraße 5, 20099, Hamburg, Germany. 5. Department of General, Visceral, Thoracic and Pediatric Surgery, Klinikum Saarbrücken, Winterberg 1, 66119, Saarbrücken, Germany. 6. Department of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany. 7. Department of Diagnostic and Interventional Radiology, Asklepios Klinik Barmbek, Rübenkamp 220, 22307, Hamburg, Germany. 8. Department of General and Visceral Surgery and Surgical Oncology, Asklepios Klinik Barmbek, Rübenkamp 220, 22307, Hamburg, Germany. 9. Department of Diagnostic and Interventional Radiology / Neuroradiology and Nuclear Medicine, Klinikum Lueneburg, Boegelstr. 1, 21339, Lüneburg, Germany.
Abstract
PURPOSE: To asses angiographic and computed tomographic success criteria during and after transcatheter arterial drug-eluting bead chemoembolization (DEB-TACE) in patients with hepatocellular carcinoma (HCC) and its impact on progression-free survival (PFS) and overall survival (OS). METHODS: In this retrospective single-center study, 50 patients with unresectable HCC having undergone DEB-TACE from January 2010 to July 2015 were assessed. The angiographic endpoint was classified by Subjective Angiographic Chemoembolization Endpoint (SACE) scale. Relative tumor density in arterial (DArt) and portal venous phase (DPV) computed tomography post- versus pre-DEB-TACE were calculated, respectively. Tumor response according to modified Response Criteria in Solid Tumors (mRECIST) was assessed. Univariate Kaplan-Meier and Cox regression analysis were carried out. RESULTS: SACE scores I, II, III, and IV were found in 1 (2%), 20 (40%), 15 (30%), and 14 (28%) patients, respectively. Median OS and PFS were 14.2 and 5.5 months, respectively. Death rates at 6 months, 1 year and 2 years were 24%, 38%, and 52%, respectively. SACE score during DEB-TACE significantly correlated with local and overall mRECIST results (local: p < 0.001, r = 0.49, overall: p = 0.042, r = 0.29) and inversely correlated with DPV (p = 0.005, r = - 0.40). In univariate analysis, progressive disease (PD) according to mRECIST and increase of DArt and DPV were associated with significantly shorter PFS. Modified RECIST independently predicted OS (hazard ratio for complete remission vs. PD = 0.15, 95% confidence interval 0.03-0.68, p = 0.014). CONCLUSIONS: A direct impact of SACE on PFS or OS could not be shown. However, SACE significantly correlated with local and overall mRECIST tumor response that again significantly predicted OS. We therefore postulate an indirect impact of SACE on OS. Consequently, complete embolization should be attempted.
PURPOSE: To asses angiographic and computed tomographic success criteria during and after transcatheter arterial drug-eluting bead chemoembolization (DEB-TACE) in patients with hepatocellular carcinoma (HCC) and its impact on progression-free survival (PFS) and overall survival (OS). METHODS: In this retrospective single-center study, 50 patients with unresectable HCC having undergone DEB-TACE from January 2010 to July 2015 were assessed. The angiographic endpoint was classified by Subjective Angiographic Chemoembolization Endpoint (SACE) scale. Relative tumor density in arterial (DArt) and portal venous phase (DPV) computed tomography post- versus pre-DEB-TACE were calculated, respectively. Tumor response according to modified Response Criteria in Solid Tumors (mRECIST) was assessed. Univariate Kaplan-Meier and Cox regression analysis were carried out. RESULTS: SACE scores I, II, III, and IV were found in 1 (2%), 20 (40%), 15 (30%), and 14 (28%) patients, respectively. Median OS and PFS were 14.2 and 5.5 months, respectively. Death rates at 6 months, 1 year and 2 years were 24%, 38%, and 52%, respectively. SACE score during DEB-TACE significantly correlated with local and overall mRECIST results (local: p < 0.001, r = 0.49, overall: p = 0.042, r = 0.29) and inversely correlated with DPV (p = 0.005, r = - 0.40). In univariate analysis, progressive disease (PD) according to mRECIST and increase of DArt and DPV were associated with significantly shorter PFS. Modified RECIST independently predicted OS (hazard ratio for complete remission vs. PD = 0.15, 95% confidence interval 0.03-0.68, p = 0.014). CONCLUSIONS: A direct impact of SACE on PFS or OS could not be shown. However, SACE significantly correlated with local and overall mRECIST tumor response that again significantly predicted OS. We therefore postulate an indirect impact of SACE on OS. Consequently, complete embolization should be attempted.
Authors: Tushar Garg; Apurva Shrigiriwar; Peiman Habibollahi; Mircea Cristescu; Robert P Liddell; Julius Chapiro; Peter Inglis; Juan C Camacho; Nariman Nezami Journal: Cancers (Basel) Date: 2022-07-10 Impact factor: 6.575