Hypovascular hepatic nodules as a predictive factor for transcatheter arterial chemoembolization refractoriness in hepatocellular carcinoma

Abstract

Aim Intermediate‐stage hepatocellular carcinoma (HCC) targeted for transcatheter arterial chemoembolization (TACE) corresponds to a highly heterogeneous population for whom the factors predicting TACE efficacy have not been established. This study aimed to evaluate the impact of hypovascular hepatic nodules coexisting with intermediate‐stage HCC as a significant predictive factor for TACE refractoriness. Methods A total of 66 patients with intermediate‐stage HCC who received initial TACE were retrospectively analyzed. Hypovascular hepatic nodules were detected by dynamic computed tomography or magnetic resonance imaging, as well as angiography, before all initial TACE. The time to TACE refractoriness (TTTR) was defined as the period from initial TACE until the diagnosis of TACE refractoriness. Results Hypovascular hepatic nodules were detected in 36 patients (54.5%), 15 (41.7%) of whom had a single nodule, whereas 21 (58.3%) had multiple nodules, and the median size of the maximum nodule was 10 mm (range 5–80 mm). The median TTTR was 17.4 months for all patients, and 7.3 and 33.1 months for patients with and without hypovascular hepatic nodules, respectively. The TTTR was significantly shorter for patients with hypovascular hepatic nodules than that for the other patients. In the multivariate analysis, the presence of hypovascular hepatic nodules (HR 7.016, 95% CI 3.534–13.930; P < 0.001) and being out of the up‐to‐seven criteria (HR 2.861, 95% CI 1.493–5.486; P = 0.002) were independent risk factors for a short TTTR. Conclusions The presence of hypovascular hepatic nodules with intermediate‐stage HCC represents a significant predictive risk factor for TACE refractoriness.

Quantitative assessment of HCC wash-out on CT is a predictor of early complete response to TACE

“…In view of an optimal treatment allocation, several studies tried to identify preoperative imaging-based predictive factors for good response to chemoembolization, mainly based on tumor size, growth rate, margins, location, and, especially, grade of hypervascularization in the arterial phase [10][11][12][13][14]. Up to approximately 30% of HCCs, however, lack a clear arterial phase hyper-enhancement [15,16], including very early HCCs, poorly differentiated HCCs, and HCC nodules with small hypervascular foci [17,18].…”

Development and Validation of a Predictive Model for Early Refractoriness of Transarterial Chemoembolization in Patients With Hepatocellular Carcinoma

“…TACE is the standard and effective therapy for intermediate-stage HCC. However, this course of treatment can be limited in terms of effectiveness as patients present TACE refractoriness (Arizumi et al, 2017;Maesaka et al, 2020). For patients with TACE FIGURE 3 | Nomogram to predict early TACE refractoriness, each predictor corresponds to a specific point by drawing a line straight upward to the points axis.…”

“…Transarterial chemoembolization (TACE) is the standard therapy for intermediate-stage HCC, which is accepted by several guidelines (Piscaglia and Ogasawara, 2018;Lee et al, 2019). However, it has been reported that not all HCC patients respond to TACE because the patients selected for TACE correspond to a highly heterogeneous population, covering a wide range of tumor burdens, liver function and treatment histories (Maesaka et al, 2020;Xue et al, 2020). Furthermore, repeated TACE procedures could gradually lead to TACE refractoriness, and some patients even show TACE failure at the very beginning of their treatment (Maesaka et al, 2020).…”

“…However, it has been reported that not all HCC patients respond to TACE because the patients selected for TACE correspond to a highly heterogeneous population, covering a wide range of tumor burdens, liver function and treatment histories (Maesaka et al, 2020;Xue et al, 2020). Furthermore, repeated TACE procedures could gradually lead to TACE refractoriness, and some patients even show TACE failure at the very beginning of their treatment (Maesaka et al, 2020). For patients with TACE refractoriness, TACE is no longer effective, and those patients are recommended to switch to a systemic therapy, as suggested by the Japan Society of Hepatology (JSH) and the Liver Cancer Study Group of Japan (LCSGJ) (Kudo et al, 2014).…”

Predictive factors for hepatocellular carcinoma recurrence after curative treatments

“…Recently, in patients with very early and early HCC, the presence of hypovascular hepatic nodules represents a significant risk factor for recurrence and a bad prognosis after treatment; this is a contraindication to the procedure in these patients [159] . Moreover, a CT image analysis method known as the parametric response map approach is more sensitive for finding changes in the response to treatment than the conventional approach based on the recap of statistics assessed on a region of interest.…”