The development of early ascites is associated with shorter overall survival in patients with hepatocellular carcinoma treated with drug-eluting embolic chemoembolization

Abstract

Background: A single-centre cohort study was performed to identify the independent factors associated with the overall survival (OS) of hepatocellular carcinoma (HCC) patients treated with transarterial chemoembolization with drug-eluting beads (DEB-TACE). Methods: A total of 216 HCC patients who underwent DEB-TACE from October 2008 to October 2015 at a tertiary hospital were consecutively recruited. The analysis of prognostic factors associated with overall survival after DEB-TACE, stressing the role of post-TACE events, was performed. Results: The objective response (OR) rate (Modified Response Evaluation Criteria in Solid Tumors (mRECIST) criteria) to the first DEB-TACE (DEB-TACE-1) was 70.3%; the median OS from DEB-TACE-1 was 27 months (95% confidence interval (CI), 24-30). In the multivariate analysis, tumor size, AFP < 100 ng/mL and serum alkaline phosphatase were independent factors for survival following DEB-TACE-1. The most important clinical event associated with poor survival was the development of early ascites after DEB-TACE-1 (median OS, 17 months), which was closely related to the history of ascites, albumin and hemoglobin but not to tumour load or to response to therapy. Conclusions: Early ascites post-DEB-TACE is associated with the survival of patients despite adequate liver function and the use of a supra-selective technical approach. History of ascites, albumin and hemoglobin are major determinants of the development of early ascites post-DEB-TACE.

Amount of ascites impacts survival in patients with hepatocellular carcinoma undergoing transarterial chemoembolization advocating for volumetric assessment

“…Moreover, development of early ascites after TACE has been shown to be associated with impaired prognosis 21 . This is in line with prior findings that have linked repeated TACE to an increase in portal hypertension and that portal hypertension is a predictor for adverse outcome in patients with liver cirrhosis and HCC 22 – 24 .…”

Transarterial Chemoembolization Combined With Endoscopic Therapy Is Beneficial for Unresectable Hepatocellular Carcinoma With Esophagogastric Varices

“…Low levels of Hb were considered to be an independent risk factor of rebleeding after EVL treatment in liver cirrhosis patients with esophageal varices (OR = 17.3491, 95% CI: 4.00–75.34, p = 0.005) ( 17 ). The occurrence of early ascites after drug-eluting bead TACE in HCC patients was associated with poor prognosis (median OS, 17 months), which was revealed to be influenced by levels of Hb before treatment ( 18 ). In patients with spontaneous ruptured HCC who were treated with TACE, higher Hb was independently associated with 30-day survival (OR = 0.609, p = 0.036) ( 19 ).…”

Combination approaches in hepatocellular carcinoma: How systemic treatment can benefit candidates to locoregional modalities

“…Guidelines recommend that patients who present progression with infiltrative tumors, vascular invasion, metastatic spread, or absence of a significant response after two TACEs should be considered for systemic treatment[ 2 , 4 ]. The risk of liver deterioration should be carefully monitored after TACE due to the prognostic impact of liver decompensation in patients with HCC[ 60 ]. The decision to declare TACE failure and switch to systemic treatment is heterogenous in different parts of the world, and many scores have been proposed to help in this decision, although some of them still require further validation in a population treated strictly according to the BCLC algorithm[ 61 - 65 ].…”