Chemoembolization for hepatocellular carcinoma: comprehensive imaging and survival analysis in a 172-patient cohort

Abstract

Purpose: To determine comprehensive imaging and long-term survival outcome following chemoembolization for hepatocellular carcinoma (HCC).

Materials and methods: One hundred seventy-two patients with HCC treated with chemoembolization were studied retrospectively in an institutional review board approved protocol; this study was HIPAA compliant. Baseline laboratory and imaging characteristics were obtained. Clinical and laboratory toxicities following treatment were assessed. Imaging characteristics following chemoembolization were evaluated to determine response rates (size and necrosis) and time to progression (TTP). Survival from the time of first chemoembolization treatment was calculated. Subanalyses were performed by stratifying the population according to Child-Pugh, United Network for Organ Sharing, and Barcelona Clinic for Liver Cancer (BCLC) staging systems.

Results: Cirrhosis was present in 157 patients (91%); portal hypertension was present in 139 patients (81%). Eleven patients (6%) had metastases at baseline. Portal vein thrombosis was present in 11 patients (6%). Fifty-five percent of patients experienced some form of toxicity following treatment; 21% developed grade 3 or 4 bilirubin toxicity. Post-chemoembolization response was seen in 31% and 64% of patients according to size and necrosis criteria, respectively. Median TTP was 7.9 months (95% confidence interval: 7.1, 9.4) but varied widely by stage. Median survival was significantly different between patients with BCLC stages A, B, and C disease (stage A, 40.0 months; B, 17.4 months; C, 6.3 months; P < .0001).

Conclusion: The determination of TTP and survival in patients with HCC is confounded by tumor biology and background cirrhosis; chemoembolization was shown to be a safe and effective therapy in patients with HCC.

Figure 1:

Waterfall plot demonstrates post-chemoembolization change in tumor size.

Figure 2a:

Kaplan-Meier curves demonstrate (a) TTP substratified by Child-Pugh class (CP) (P = .1351), (b) survival substratified by Child-Pugh class (P = .2927), (c) TTP substratified by UNOS stage (P = .0001), (d) survival substratified by UNOS stage (P < .0001). Kaplan-Meier curves show (e) TTP substratified by BCLC stage (P = .0009), and (f) survival substratified by BCLC stage (P < .0001).

Figure 2b:

Kaplan-Meier curves demonstrate (a) TTP substratified by Child-Pugh class (CP) (P = .1351), (b) survival substratified by Child-Pugh class (P = .2927), (c) TTP substratified by UNOS stage (P = .0001), (d) survival substratified by UNOS stage (P < .0001). Kaplan-Meier curves show (e) TTP substratified by BCLC stage (P = .0009), and (f) survival substratified by BCLC stage (P < .0001).

Figure 2c:

Kaplan-Meier curves demonstrate (a) TTP substratified by Child-Pugh class (CP) (P = .1351), (b) survival substratified by Child-Pugh class (P = .2927), (c) TTP substratified by UNOS stage (P = .0001), (d) survival substratified by UNOS stage (P < .0001). Kaplan-Meier curves show (e) TTP substratified by BCLC stage (P = .0009), and (f) survival substratified by BCLC stage (P < .0001).

Figure 2d:

Kaplan-Meier curves demonstrate (a) TTP substratified by Child-Pugh class (CP) (P = .1351), (b) survival substratified by Child-Pugh class (P = .2927), (c) TTP substratified by UNOS stage (P = .0001), (d) survival substratified by UNOS stage (P < .0001). Kaplan-Meier curves show (e) TTP substratified by BCLC stage (P = .0009), and (f) survival substratified by BCLC stage (P < .0001).

Figure 2e:

Kaplan-Meier curves demonstrate (a) TTP substratified by Child-Pugh class (CP) (P = .1351), (b) survival substratified by Child-Pugh class (P = .2927), (c) TTP substratified by UNOS stage (P = .0001), (d) survival substratified by UNOS stage (P < .0001). Kaplan-Meier curves show (e) TTP substratified by BCLC stage (P = .0009), and (f) survival substratified by BCLC stage (P < .0001).

Figure 2f:

Kaplan-Meier curves demonstrate (a) TTP substratified by Child-Pugh class (CP) (P = .1351), (b) survival substratified by Child-Pugh class (P = .2927), (c) TTP substratified by UNOS stage (P = .0001), (d) survival substratified by UNOS stage (P < .0001). Kaplan-Meier curves show (e) TTP substratified by BCLC stage (P = .0009), and (f) survival substratified by BCLC stage (P < .0001).