Study of predictive factors of complete response after chemoembolization for unresectable hepatocellular carcinoma in 162 patients

Abstract

Aim of the study:To study clinical, laboratory and imaging features correlated with complete response (CR) to transarterial chemoembolization (TACE) in patients with unresectable hepatocellular carcinoma (HCC) through 162 patients collected in Hassan II University Hospital of Fez. Material and methods: From January 2015 to December 2019, 162 patients diagnosed with 225 HCC were treated by TACE. Among them, 14 showed CR during the follow-up. Imaging response was evaluated using the modified Response Evaluation Criteria in Solid Tumors (mRECIST). A multivariate analysis was performed including demographic parameters, etiology, α-fetoprotein (AFP) rates, hepatic function scores, imaging and TACE features. In cases with complete response and remission, follow-up duration was considered from the first to the last imaging control showing no viable tumor and eventually nodule retraction. Results: Among the 162 patients with 225 nodules, 14 (9%) of them showed remission and 148 (91%) did not. There was no significant difference between the two groups in age, performance status (PS), AFP, nodularity, size nodule or number of TACE cures. Sex, etiology, Child-Pugh and MELD scores, location, BCLC stage and blush extinction were all found to have a significant impact on therapeutic response. Conclusions: This study demonstrates that CR of HCC treated by TACE is strongly correlated with male sex, etiology (viral hepatitis C), location (segments VI and VII) and complete blush extinction on digital subtraction angiography (DSA). No significant correlation was found, particularly that of tumor size and segment IV (as a pejorative location).

Association of serum AFP trajectories and hepatocellular carcinoma outcomes after hepatic arterial infusion chemotherapy: A longitudinal, multicenter study

“…Previously, numerous studies reported that the change in AFP levels before and after targeted chemotherapy plays a crucial role in the therapeutic response. 30,31 Therefore, AFP decline was the robust subclass across all stages of HCC, which supported the finding of AFP serological response and implied a specified pathophysiological process. Linbin Lu et al proposed the application of AFP trajectories for the prediction of outcomes of patients with intermediatestage HCC who underwent TACE, 21 which has been confirmed by the above hypothesis.…”

Segmental Distribution of Hepatocellular Carcinoma in Cirrhotic Livers

“…In fact, when a lesion is situated in the deeper segments, such as 4b, 7 and 8, the rate of successful bioptic sampling can be diminished due to the technical difficulties in reaching these less accessible locations [31,32]. Similarly, the precise definition of a tumour site allows its adjacency to large vessels, the biliary tree, the liver capsule or other important tissues, such as the diaphragm or gastrointestinal tracts, to be evaluated for the most appropriate and effective therapeutic choice, whether it is percutaneous or surgical [3,[15][16][17][18][19][20]. However, in addition to these technical and prognostic implications, only a few studies have analysed the spatial distribution of HCC with reference to Couinaud's segments [28].…”

“…In addition, the overall survival and local tumour progression rates were poorer for tumours located in segment 2, probably due to being adjacent to the diaphragm and heart and the consequent difficulty in detecting the lesion under US guidance [19]. Finally, other locations are associated with positive outcomes: for example, segments 6 and 7 were strongly associated with a complete response to TACE in patients with unresectable HCC [20].…”

Predicting the Initial Treatment Response to Transarterial Chemoembolization in Intermediate-Stage Hepatocellular Carcinoma by the Integration of Radiomics and Deep Learning

“…The high baseline levels of AFP (> 20 ng/mL) may not be related to the initial therapy response, but several studies have reported that the AFP decline was associated with treatment response and significantly improved median survival in intermediate-stage HCC after TACE therapy (32)(33)(34). Tumor number is an uncertain predictive biomarker of treatment response in different centers, and the outcome needs more studies for confirmation (35,36). In addition to clinical variables, the predictive performance of the radiomics model in the study was similar to that of our linear and logistic models but was lower than that of the SVM, RF, and GBM models, which revealed that the optimal feature selection is important for building a precise model.…”