Radiologic Patterns Determine the Outcomes of Initial and Subsequent Transarterial Chemoembolization in Intermediate-Stage Hepatocellular Carcinoma

Ya-Wen Hung; I-Cheng Lee; Chen-Ta Chi; Rheun-Chuan Lee; Chien-An Liu; Nai-Chi Chiu; Hsuen-En Hwang; Yee Chao; Ming-Chih Hou; Yi-Hsiang Huang

doi:10.1159/000530950

Radiologic Patterns Determine the Outcomes of Initial and Subsequent Transarterial Chemoembolization in Intermediate-Stage Hepatocellular Carcinoma

Liver Cancer. 2023 May 15;13(1):29-40. doi: 10.1159/000530950. eCollection 2024 Feb.

Authors

Ya-Wen Hung^{1

2}, I-Cheng Lee^{1

3}, Chen-Ta Chi^{1

3

4}, Rheun-Chuan Lee⁵, Chien-An Liu⁵, Nai-Chi Chiu⁵, Hsuen-En Hwang⁵, Yee Chao⁶, Ming-Chih Hou^{1

3}, Yi-Hsiang Huang^{1

3

4

7}

Affiliations

¹ Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
² Health Examination Center, Taipei Veterans General Hospital, Taoyuan Branch, Taoyuan, Taiwan.
³ Faculty of Medicine, National Yang Ming Chiao Tung University School of Medicine, Taipei, Taiwan.
⁴ Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
⁵ Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan.
⁶ Cancer Center, Taipei Veterans General Hospital, Taipei, Taiwan.
⁷ Healthcare and Services Center, Taipei Veterans General Hospital, Taipei, Taiwan.

Abstract

Introduction: Outcomes of transarterial chemoembolization (TACE) for intermediate-stage hepatocellular carcinoma (HCC) are diverse because of the heterogeneity of tumor burden. Radiologic pattern is one criterion for determining whether TACE is unsuitable. However, additional evidence is required. This study determined the influence of radiologic morphology on the outcomes of initial and subsequent TACE.

Methods: From January 2007 to September 2021, 633 treatment-naive patients with HCC with intermediate-stage HCC undergoing TACE were retrospectively enrolled. Of these patients, 386 patients received repeated TACE. The radiological features of HCC were evaluated by two radiologists and classified into encapsulated nodular type, simple nodular type with extranodular growth, confluent multinodular type, and infiltrative type. The objective response rate (ORR) and survival rate after initial and subsequent TACE among various radiologic morphologies were compared.

Results: After initial TACE, encapsulated nodular type HCC had the highest ORR (58%), followed by extranodular type (45.8%), confluent multinodular type (29%), and infiltrative type (19.5%). Notably, radiologic pattern was highly associated with tumor burden. Tumor burden and radiologic morphology were significantly associated with ORR and overall survival (OS) in the multivariate analysis. In 386 patients with subsequent TACE, encapsulated nodular type HCC had the highest ORR (48.7%), followed by extranodular type (37.3%), confluent multinodular type (26.2%), and infiltrative type (10%). In the multivariate analysis, radiologic features were significant independent predictors of ORR and OS after receiving subsequent TACE.

Conclusion: Radiologic patterns determine the outcomes of initial and subsequent TACE. Systemic therapy should be considered for patients with intermediate-stage HCC with unfavorable radiologic patterns.

Keywords: Hepatocellular carcinoma; Overall survival; Radiologic patterns; Transarterial chemoembolization refractory; Transarterial chemoembolization unsuitable.

Grants and funding

The study was supported by grants from Taipei Veterans General Hospital, Taipei, Taiwan (V111A-001, V109C-048, V110C-144, V111C-107, V112C-070) and National Science and Technology Council, Taiwan (MOST 109-2314-B-010 -034 -MY3).