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. 2023 Mar 24;7(4):e0091.
doi: 10.1097/HC9.0000000000000091. eCollection 2023 Apr 1.

Stage migration as a surrogate of survival in hepatocellular carcinoma treated with transarterial chemoembolization

Ihab Kassab  1 , Amit G Singal  2 , Aamir Ali  3 , Manasa Narasimman  2 , Ashwini Arvind  2 , Muneeb Ahmed  3 , Sagar Joshi  1 , Komal Manzoor  3 , Nicole Rich  2 , Vincent L Chen  1 , Zhe Zhao  1 , Ammar Sarwar  3 , Neehar D Parikh  1
Affiliations

Stage migration as a surrogate of survival in hepatocellular carcinoma treated with transarterial chemoembolization

Ihab Kassab et al. Hepatol Commun. .

Abstract

Background aims: Locoregional therapies, including transarterial chemoembolization (TACE), are recommended for the treatment of HCC; however, clinical trials evaluating their effectiveness have been complicated by a lack of validated surrogate outcomes. We aimed to evaluate if stage migration could serve as a potential surrogate of overall survival in patients undergoing TACE.

Approach: We conducted a retrospective cohort study of adult patients with HCC who underwent TACE as initial therapy from 3 centers in the US from 2008 to 2019. The primary outcome was overall survival from the date of the first TACE treatment, and the primary exposure of interest was Barcelona Clinic Liver Cancer stage migration to a more advanced stage within 6 months of TACE. Survival analysis was completed using Kaplan-Meier and multiple Cox proportional hazard models adjusted by the site.

Results: Of 651 eligible patients (51.9% Barcelona Clinic Liver Cancer stage A and 39.6% stage B), 129 (19.6%) patients experienced stage migration within 6 months of TACE. Those with stage migration had larger tumors (5.6 vs. 4.2 cm, p < 0.01) and higher AFP levels (median 92 vs. 15 ng/mL, p < 0.01). In multivariate analysis, stage migration was significantly associated with worse survival (HR: 2.82, 95% CI: 2.66-2.98), with a median survival of 8.7 and 15.9 months in those with and without stage migration. Other predictors of worse survival included the White race, higher AFP levels, a higher number of tumors, and a larger maximum HCC diameter.

Conclusion: Stage migration is associated with increased mortality after TACE in patients with HCC and could serve as a surrogate end point in clinical trials evaluating locoregional therapies such as TACE.

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Conflict of interest statement

Amit G. Singal served as a consultant or on advisory boards for Genentech, Astra Zeneca, Bayer, Eisai, Exelixis, FujiFilm Medical Sciences, Exact Sciences, Roche, Glycotest, and GRAIL. Neehar D. Parikh served as a consultant for Exact Sciences, Eli Lilly, and Freenome; has served on advisory boards of Genentech, Eisai, Bayer, Exelixis, Wako/Fujifilm; and has received research funding from Bayer, Target RWE, Exact Sciences, Genentech and Glycotest. The remainder authors have no conflicts to report.

Figures

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Graphical abstract
FIGURE 1
FIGURE 1
(A) Overall survival after TACE, stratified by stage migration status. (B) Landmark analysis with overall survival after initial TACE, stratified by stage migration status. Abbreviation: TACE indicates transarterial chemoembolization.
See this image and copyright information in PMC

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