Initial treatment response to transarterial chemoembolization as a predictive factor for Child–Pugh class deterioration prior to refractoriness in hepatocellular carcinoma

Abstract

Aim: Repeated transarterial chemoembolization (TACE) for intermediate-stage hepatocellular carcinoma (HCC) eventually leads to either deteriorated hepatic reserve or TACE refractoriness. Switching to molecular targeted agents after TACE requires preservation of hepatic reserve. This study aimed to investigate the predictive factors associated with early deterioration of hepatic reserve by repeated TACE prior to refractoriness. Methods: Ninety-three patients with intermediate-stage HCC who underwent TACE as the first-line treatment and had a Child-Pugh class A hepatic reserve were retrospectively analyzed. The time to Child-Pugh class deterioration (TTCPD), defined as the duration from initial TACE to the diagnosis of Child-Pugh class B or C prior to TACE refractoriness, was assessed. Patients who progressed to TACE refractoriness prior to Child-Pugh class deterioration were censored at TACE refractoriness. Results: The radiological response to initial TACE was assessed as responders and non-responders in 59 (63.4%) and 34 (36.6%) patients, respectively. The median TTCPD was 40.6 months in all patients. The hepatic reserve in 31 (33.3%) patients deteriorated to Child-Pugh class B or C prior to TACE refractoriness. In the multivariate analysis, non-response to initial TACE, albumin-bilirubin grade 2, and non-selective TACE were identified as independent predictors associated with a shortened TTCPD. The TTCPD was significantly shorter in the non-responders than in the responders to initial TACE (median, 19.6 vs. 55.9 months; P<0.001). Conclusions: Failure to respond to initial TACE was a predictive factor for early deterioration of hepatic reserve prior to TACE refractoriness in intermediate-stage HCC patients with repeated TACE.

Child–Pugh grade deterioration stratified by the etiology after transcatheter arterial chemoembolization as initial treatment for hepatocellular carcinoma

“…The diagnosis of HCC was based on histopathological findings by liver biopsy or characteristic radiological findings, such as contrast enhanced computer tomography (CT) or contrast enhanced magnetic resonance imaging (MRI). Barcelona Clinic Liver Cancer (BCLC) stage was used for the evaluation of HCC staging 9 , 10 . Underlying liver diseases were categorized according to the presence of chronic hepatitis infection.…”

“…The psoas muscle area index (psoas muscle area at the middle of the third lumbar vertebra (cm 2 )/height (m) 2 ) was manually calculated from CT findings at diagnosis of HCC. The presence of sarcopenia was then judged by the cut off value proposed by Hamaguchi et al 38 AASLD guidelines for the treatment of HCC were used for the selection of initial treatment 10 . After initial TACE, patients underwent regular follow-up with measurement of blood samples and CT or MRI examinations every 1 to 3 months.…”

“…TACE is recommended for unresectable HCC. TACE has shown to be most effective when the number and size of tumors were limited 10 . However, TACE deteriorates liver functions 11 , 12 .…”

Longer Survival and Preserved Liver Function after Proton Beam Therapy for Patients with Unresectable Hepatocellular Carcinoma

“…TACE relies on the strong arterial supply of HCC, aiming for complete anoxia inside the malignancy, inducing an ischemic response and causing tumor necrosis. At the same time, it damages the surrounding liver parenchyma and exacerbates the functional hepatic reserve, which leads to a worse prognosis for patients with HCC complicated with chronic liver diseases [ 7 , 8 ].…”