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. 2019 Feb;42(2):230-238.
doi: 10.1007/s00270-018-2118-6. Epub 2018 Nov 28.

Reason of Discontinuation After Transarterial Chemoembolization Influences Survival in Patients with Hepatocellular Carcinoma

Tim A Labeur  1   2 , R Bart Takkenberg  3 , Heinz-Josef Klümpen  1   2 , Otto M van Delden  4
Affiliations

Reason of Discontinuation After Transarterial Chemoembolization Influences Survival in Patients with Hepatocellular Carcinoma

Tim A Labeur et al. Cardiovasc Intervent Radiol. 2019 Feb.

Erratum in

Abstract

Background: Transarterial chemoembolization (TACE) for intermediate-stage hepatocellular carcinoma (HCC) is often repeated until unTACEable progression (UTP) occurs. There is little data on the various reasons for stopping TACE and its consequences for subsequent treatment and survival.

Aim: To assess the impact of the various reasons of UTP on survival and consequences for subsequent treatments.

Methods: Consecutive HCC patients who underwent TACE between 2003 and 2016 were analyzed retrospectively for the reason of TACE discontinuation. UTP was defined according to the EASL guidelines, considering radiological pattern of progression, liver function and performance status (PS). Overall and post-progression survival (OS, PPS) for different reasons of TACE discontinuation were compared. The correlation between time to untreatable progression by chemoembolization (TTUPc) and OS was analyzed.

Results: One hundred and sixty-six patients (BCLC-A 40%, BCLC-B 54%, BCLC-C: 7%) were included, undergoing a median of 2 TACE procedures with a median OS of 22.1 months (95% CI 17.4-26.7). UTP occurred in 116 patients (70%) after a median TTUPc of 11.6 months (95% CI 7.8-15.4). There was a strong positive correlation (ρ = 0.816, p < 0.001) between TTUPc and OS. The main reason of UTP was radiological progression (61%), which was mostly intrahepatic (75%). Hepatic decompensation and worsening of PS were independent predictors of OS and PPS.

Conclusion: The majority of HCC patients treated with TACE have UTP due to intrahepatic tumor progression with preserved liver function and PS, making them potential candidates for subsequent liver-directed or systemic treatment. TTUPc may be a valuable surrogate endpoint for OS in patients treated with TACE.

Level of evidence: Level II, prognosis study.

Keywords: Discontinuation; Hepatocellular carcinoma; Survival; TACE; Time to untreatable progression by chemoembolization; Transarterial chemoembolization.

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Conflict of interest statement

Conflict of interest

Heinz-Josef Klümpen is a member of the advisory board for Ipsen and Sirtex and received an unrestricted research grant from Bayer (no grant numbers apply). Bart Takkenberg, served as a speaker for Gore WL, Bayer and Norgine, is a member of the advisory board for Gilead and has received grants from the Netherlands Organisation for Health Research and Development (ZonMw) and The Netherlands Society for Gastroenterology (Gastrostart). Otto van Delden served as a consultant for Cook Medical. Tim Labeur declared no conflicts of interest. The study was designed and conducted by academic investigators.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.

Informed Consent

This study has obtained IRB approval from the Amsterdam UMC, and the need for informed consent was waived.

Consent for Publication

For this type of study, consent for publication is not required.

Figures

Fig. 1
Fig. 1
Consort flow diagram. BCLC Barcelona Clinic Liver Cancer; ECOG PS Eastern Cooperative Oncology Group performance status; HCC hepatocellular carcinoma; LiverTx liver transplantation; MVI macrovascular invasion; PD progressive disease; RE radioembolization; SBRT stereotactic body radiotherapy (SBRT); TACE transarterial chemoembolization
Fig. 2
Fig. 2
Scatter plots of the correlation between overall survival (OS) and A time to untreatable progression (TTUPc) B post-progression survival (PPS)
Fig. 3
Fig. 3
A Overall survival (OS) and B post-progression survival (PPS) according to reason of unTACEable progression (UTP). ECOG PS Eastern Cooperative Oncology Group performance status
Fig. 4
Fig. 4
Post-progression survival (PPS) according to radiological pattern of progression. EHS extrahepatic spread; MVI macrovascular invasion
See this image and copyright information in PMC

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