Prognostic effect of transarterial chemoembolization–induced complete pathological response in patients undergoing liver resection and transplantation for hepatocellular carcinoma

Abstract

Transarterial chemoembolization (TACE)-induced complete pathological response (CPR) is known to improve postresection outcomes of hepatocellular carcinoma (HCC). We aimed to assess the prognostic effects of CPR after preoperative TACE for HCC in patients who underwent hepatic resection (HR) or liver transplantation (LT). The clinical outcomes of patients showing CPR after HR (n = 110) or LT (n = 233) were analyzed. The control groups comprised patients with minimal recurrence risk as naïve single HCC ≤ 2 cm for HR (n = 476), and 1 or 2 HCCs ≤ 2 cm for LT (n = 184). Among HR study patients, 1-, 3-, and 5-year tumor recurrence rates were 18.5%, 50.6%, and 58.7% respectively, which were higher than those of controls (P < 0.001). The 1-, 3-, and 5-year patient survival rates were 97.8%, 82.0%, and 69.1%, respectively, which were lower than those of controls (P < 0.001). Among LT study patients, 1-, 3-, and 5-year tumor recurrence rates were 4.1%, 7.9%, and 7.9%, respectively, which were higher than those of controls (P = 0.019). The 1-, 3-, and 5-year patient survival rates were 92.7%, 89.2%, and 86.9%, respectively, which were not different than those of controls (P = 0.11). LT recipients had lower recurrence and higher survival rates compared with HR patients (P < 0.001). The tumor recurrence site was mainly intrahepatic in HR patients. There was no difference between the incidences of extrahepatic recurrence in the HR study group and all-site recurrence in the LT study group (P = 0.61). We concluded that the prognostic effect of TACE-induced CPR for HCC patients appears to be limited to downstaging. LT recipients benefited more from CPR than HR patients. Liver Transplantation 23 781-790 2017 AASLD.

Long-term complete response after transcatheter arterial chemoembolization and stereotactic body radiation therapy in a patient with hepatocellular carcinoma at the caudate lobe

“…The transhepatic approach, dividing the hepatic parenchyma to expose the paracaval portion, is a feasible method used to reduce the risk of tumor handling-associated tumor spread. Downstaging with preoperative TACE had been attempted, but its therapeutic effect was worse than expected 711. HR, used only a few months after TACE, should be avoided because the integrity of the HCC cells is loosened, by which the risk of intraoperative tumor spread increases.…”

A versatile UCST-type composite microsphere for image-guided chemoembolization and photothermal therapy against liver cancer

“…Previous studies have reported that the extent of tumor necrosis correlated with prognosis. 12,14 However, it remains challenging for TACE per se to eliminate tumor cells entirely and the residual viable tumor cells are the important sources of rapid recurrence and tumor progression that remarkably deteriorate the patient prognosis. In a large-scale study analyzing over 3000 cases, the pathologically proved complete necrosis can only be achieved in 22.4% of the patients who received TACE treatment alone; and even for patients subjected to combined therapy of TACE and thermal ablation, pathological CR rate merely increased to 26.0%.…”

“…15 Furthermore, it is much more difficult to achieve pathological complete necrosis compared to imaging criteria, and previous studies reported that residual tumor cells can be found in most (89%) of the lesions which were determined as CR in imaging analysis. [12][13][14] Therefore, it is critical to explore novel strategies for enhancing liver tumor eradication.…”

“…It has been demonstrated that the magnitude of tumor necrosis, in terms of treatment response which is usually assessed by contrast enhanced imaging studies, correlated closely with prognosis. [11][12][13][14][15] Unfortunately, TACE alone can hardly eliminate tumor cells entirely, as only around half of the patients who were subjected to TACE achieved complete response (CR) according to the imaging study. 11 Pathological complete necrosis is even more difficult to achieve as viable tumor cells can be detected in the majority of the lesions after TACE treatment.…”

“…11 Pathological complete necrosis is even more difficult to achieve as viable tumor cells can be detected in the majority of the lesions after TACE treatment. [12][13][14][15] The residual tumor cells account for the rapid tumor recurrence and progression that substantially deteriorate the prognosis. However, little improvement has been made that chemoembolization agents of new generation such as drug eluting beads (DEBs) failed in providing better overall survival (OS) for patients compared to conventional agents.…”