TY - JOUR
T1 - Role of tumor margin and ADC change in defining the need for additional treatments after the first TACE in patients with unresectable HCC
AU - Shaghaghi, Mohammadreza
AU - AliyariG hasabeh, Mounes
AU - Ameli, Sanaz
AU - Ghadimi, Maryam
AU - Hazhirkarzar, Bita
AU - Rezvani Habibabadi, Roya
AU - Tang, Hao
AU - Khoshpouri, Pegah
AU - Wu, Qingxia
AU - Pandey, Ankur
AU - Pandey, Pallavi
AU - Baghdadi, Azarakhsh
AU - Kamel, Ihab R.
N1 - Publisher Copyright:
© 2020
PY - 2020/12
Y1 - 2020/12
N2 - Purpose: To define the number of TACE sessions needed to improve patients’ overall survival (OS) in different subgroups of unresectable HCC. Methods: This retrospective cohort included 180 patients who got TACE between 2005–2016 as the initial treatment for unresectable HCC. Tumor margin (well- vs. ill-defined) was determined by two radiologists at baseline. Well-defined group was divided into two groups (ADC-responders vs. ADC-nonresponders) based on %ADC change (ΔADC-cutoff = 25 %). Accordingly, patients were categorized into three groups, ill-defined, well-defined ADC-responders, or well-defined ADC-nonresponders. Cox-analysis was used to compare the survival benefit of multiple TACE in different groups. Results: Ill-defined HCC (n = 108) was associated with worse survival (HR = 1.95,p < 0.001). Multiple TACE were associated with increased OS (HR = 0.88,p = 0.033) in these patients, with significant survival improvement after ≥4TACE. ΔADC was not related to OS in ill-defined group. In well-defined group (n = 72), multiple TACE were not associated with improved OS (HR = 0.181,p = 0.090). These patients were categorized into two groups based on ΔADC-cutoff. ADC-responders (ΔADC≥25 %) had the longest survival than other groups(p = 0.015). Multiple TACE sessions were not associated with better OS in this group (HR = 1.004,p = 0.982). By contrast, incremental number of TACE were associated with significantly longer OS in ADC-nonresponders (ΔADC<25 %) (HR = 0.79,p = 0.034). These patients’ OS significantly improved after ≥3TACE. Conclusion: The survival benefit of sequential TACE sessions varies for different HCC subgroups. There was no significant survival benefit associated with multiple TACE in well-defined lesions responding to the first TACE. The most survival benefit was for ADC-nonresponder well-defined group and it was least for ill-defined HCC group, regardless of ADC-response.
AB - Purpose: To define the number of TACE sessions needed to improve patients’ overall survival (OS) in different subgroups of unresectable HCC. Methods: This retrospective cohort included 180 patients who got TACE between 2005–2016 as the initial treatment for unresectable HCC. Tumor margin (well- vs. ill-defined) was determined by two radiologists at baseline. Well-defined group was divided into two groups (ADC-responders vs. ADC-nonresponders) based on %ADC change (ΔADC-cutoff = 25 %). Accordingly, patients were categorized into three groups, ill-defined, well-defined ADC-responders, or well-defined ADC-nonresponders. Cox-analysis was used to compare the survival benefit of multiple TACE in different groups. Results: Ill-defined HCC (n = 108) was associated with worse survival (HR = 1.95,p < 0.001). Multiple TACE were associated with increased OS (HR = 0.88,p = 0.033) in these patients, with significant survival improvement after ≥4TACE. ΔADC was not related to OS in ill-defined group. In well-defined group (n = 72), multiple TACE were not associated with improved OS (HR = 0.181,p = 0.090). These patients were categorized into two groups based on ΔADC-cutoff. ADC-responders (ΔADC≥25 %) had the longest survival than other groups(p = 0.015). Multiple TACE sessions were not associated with better OS in this group (HR = 1.004,p = 0.982). By contrast, incremental number of TACE were associated with significantly longer OS in ADC-nonresponders (ΔADC<25 %) (HR = 0.79,p = 0.034). These patients’ OS significantly improved after ≥3TACE. Conclusion: The survival benefit of sequential TACE sessions varies for different HCC subgroups. There was no significant survival benefit associated with multiple TACE in well-defined lesions responding to the first TACE. The most survival benefit was for ADC-nonresponder well-defined group and it was least for ill-defined HCC group, regardless of ADC-response.
KW - Carcinoma
KW - Chemoembolization
KW - Diffusion magnetic resonance imaging
KW - Hepatocellular
KW - Survival analysis
KW - Therapeutic
KW - Treatment outcome
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U2 - 10.1016/j.ejrad.2020.109389
DO - 10.1016/j.ejrad.2020.109389
M3 - Article
C2 - 33166831
AN - SCOPUS:85095754170
SN - 0720-048X
VL - 133
JO - European Journal of Radiology
JF - European Journal of Radiology
M1 - 109389
ER -