Predictive factors of tumor response to trans-catheter treatment in cirrhotic patients with hepatocellular carcinoma: a multivariate analysis of pre-treatment findings.
OBJECTIVE
To elucidate the pre-treatment clinical and imaging findings affecting the tumor response to the transcatheter treatment of unresectable hepatocellular carcinoma (HCC).


METHODS
Two hundred cirrhotic patients with HCC received a total of 425 transcatheter treatments. The tumor response was evaluated by helical CT and a massive necrosis (MN) was defined as a necrosis > 90%. Twenty-five clinical and imaging variables were analyzed: uninodular/multinodular HCC, unilobar/bilobar, tumor capsula, hypervascular lesion, portal vein thrombosis, portal hypertension, ascites, platelets count, aspartate transaminases/alanine transaminases (AST/ALT), alfa-fetoprotein (AFP) > 100, AFP > 400, serum creatinine, virus hepatitis C (VHC) cirrhosis, performance status, age, Okuda stage, Child-Pugg stage, sex, CLIP (Cancer of the Liver Italian Program) score, serum bilirubin, constitutional syndrome, serum albumine, prothrombin activity, BCLC (Barcelona Clinic Liver Cancer) stage. Prognostic factors of response were subjected to univariate analysis and thereafter, when significant, to the multivariate analyses.


RESULTS
On imaging analysis, complete response was obtained in 60 (30%) patients, necrosis > 90% in 38 (19%) patients, necrosis > 50% in 44 (22%) patients, and necrosis < 50% in 58 (29%) patients. Ninety-eight (49%) of the 200 patients were considered to have a MN. In univariate analysis, significant variables (P < 0.01) were: uninodular tumor, unilobar, tumor size 2-6 cm, CLIP score < 2, absence of constitutional syndrome, and BCLC stage < 2. In a multivariate analysis, the variables reaching statistical significance were: presence of tumor capsule (P < 0.0001), tumor size 2-6 cm (P < 0.03), CLIP score < 2 (P < 0.006), and absence of constitutional syndrome (P < 0.03). Kaplan-Mayer cumulative survival at 12 mo was 80% at 24 mo was 56%. MN was associated with a longer survival (P < 0.0001).


CONCLUSIONS
MN after transcatheter treatment is more common in the presence of tumor capsule, maximum diameter of the main lesion between 2 and 6 cm, CLIP score < 2 and absence of constitutional syndrome. The ability to predict which patients will respond to transcatheter treatment may be useful in the clinical decision-making process, and in stratifying the randomization of patients in clinical trials.
Miraglia
Roberto
R
Department of Radiology, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IsMeTT), University of Pittsburgh Medical Center, IsMeTT, Via Tricomi 1, Palermo 90127, Italy. rmiraglia@ismett
Pietrosi
Giada
G
Maruzzelli
Luigi
L
Petridis
Ioannis
I
Caruso
Settimo
S
Marrone
Gianluca
G
Mamone
Giuseppe
G
Vizzini
Giovanni
G
Luca
Angelo
A
Gridelli
Bruno
B
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D002404:Catheterization; D015331:Cohort Studies; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D008113:Liver Neoplasms / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D012189:Retrospective Studies; D016896:Treatment Outcome