Role of tumor margin and ADC change in defining the need for additional treatments after the first TACE in patients with unresectable HCC

Mohammadreza Shaghaghi, Mounes AliyariG hasabeh, Sanaz Ameli, Maryam Ghadimi, Bita Hazhirkarzar, Roya Rezvani Habibabadi, Hao Tang, Pegah Khoshpouri, Qingxia Wu, Ankur Pandey, Pallavi Pandey, Azarakhsh Baghdadi, Ihab R. Kamel

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish (US)
Article number109389
JournalEuropean Journal of Radiology
Volume133
DOIs
StatePublished - Dec 2020

Keywords

  • Carcinoma
  • Chemoembolization
  • Diffusion magnetic resonance imaging
  • Hepatocellular
  • Survival analysis
  • Therapeutic
  • Treatment outcome

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

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