1. Department of Hepatobiliary Oncology of the Sun Yat-sen University Cancer Center; Guangzhou 510060, P.R. China
2. Department of Radiation Oncology of the Sun Yat-sen University Cancer Center, Guangzhou 510060, P.R. China
3. Department of Ultrasound of the Sun Yat-sen University Cancer Center, Guangzhou 510060, P.R. China
4. Department of pathology of the Sun Yat-sen University Cancer Center, Guangzhou 510060, P.R. China
5. State Key Laboratory of Oncology in South China, Guangzhou 510060, P.R. China
6. Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, P.R. China
7. Department of Burn and Plastic Surgery, 2nd Affiliated Hospital of Shantou University Medical College, Shantou 515041, China
*These authors equally contributed to this study.
Aim: To investigate the risk factors of extra-hepatic progression after TACE in HCC.
Methods: The study population included 654 HCC patients who underwent TACE between October 2005 and September 2012. We collected and analyzed their clinical characteristics and survival information. TACE was performed as previously described with minor modifications. When necessary, superselective chemoembolization was performed through the segmental or subsegmental arteries, based on the tumor location and extent and hepatic function reserve. If stasis could not be achieved in a tumor-feeding artery, iodized oil was used solely in some patients. Embolization was then performed with injection of absorbable gelfoam particles (1-2 mm in diameter) through the angiographic catheter.
Results: The tumor response to initial TACE was evaluated in 645 patients. The CR rate, response rate (RR), and disease control rate (DCR) were 9.92%, 25.89%, and 70.39%, respectively. The median overall survival (OS) period was 14.5 months. The 6-month, 1-, 2-, 3-, and 5-year OS rates were 75.5%, 55.0%, 33.9%, 22.8%, and 14.9%, respectively. The median progression-free survival (PFS) period was 4.3 months. The 6-month, 1-, 2-, 3-, and 5-year PFS rates were 40.7%, 27.1%, 16.7%, 13.9%, and 9.3%, respectively. One hundred and fifty patients developed extrahepatic progression during follow-up. We demonstrated that in the absence of radical treatment after initial TACE (p<0.001), the presence of extrahepatic metastasis before initial TACE (p<0.001), AST >45 U/L (p=0.024), ALB <35 g/L (p=0.012), and tumor response were evaluated as PD and SD after initial TACE (p<0.001) and were found to be independent predictors of a poorer prognosis of extrahepatic PFS.
Conclusions: We identified risk factors for extrahepatic progression after TACE in HCC patients. Early combination treatment was strongly recommended in patients that met these risk factors.
Keywords: hepatocellular carcinoma, transarterial chemoembolization, extrahepatic progression, risk factor