title: Early identification of poor responders to transarterial chemoembolization for hepatocellular carcinoma.
abstract: OBJECTIVE
  Transarterial chemoembolization (TACE) is used to treat unresectable hepatocellular carcinoma (HCC). However, HCC patients may have an even shorter survival after TACE. This study aimed to identify poor responders to TACE at an early stage.
  
  
  METHODS
  A total of 624 and 122 patients with HCC undergoing TACE and best supportive care (BSC), respectively, were analyzed. Poor responders were defined as patients who died after TACE or had viable tumor(s), but not eligible for further treatment at 3 months of treatment.
  
  
  RESULTS
  A total of 102 (16%) patients were identified as poor responders. Poor responders had a significantly decreased long-term survival than other patients receiving TACE and a tendency of higher risk of mortality than patients receiving BSC (p < 0.001 and p = 0.054, respectively). The comparison of 24-month survival showed significantly worse outcome in poor responders than patients receiving BSC (p = 0.04). Serum α-fetoprotein (AFP) level >40 ng/mL (p = 0.024) and albumin level 3.8 g/dL (p = 0.016), Child-Turcotte-Pugh (CTP) class B (p = 0.011), performance status 1 (p < 0.001), total tumor volume (TTV) >65 cm(3) (p = 0.001), and vascular invasion (p = 0.005) were independent risk factors predicting poor response at 3 months in the multivariate logistic regression analysis. Among the four HCC staging systems, the Barcelona Clinic Liver Cancer (BCLC) classification showed the highest predictive accuracy for the identification of poor responders.
  
  
  CONCLUSIONS
  Poor responders have an increased risk of mortality due to rapid disease progression after TACE. Advanced BCLC stages may better predict a poor response to TACE.
authors.affiliation: School of Nursing, National Yang-Ming University, Taipei, Taiwan.|Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan.|School of Nursing, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Ya-Ju
authors.initials: YJ
authors.lastname: Tsai
authors.affiliation: Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.|Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.|Department of Medicine, National Yang-Ming University Hospital, Yilan, Taiwan.
authors.forename: Chia-Yang
authors.initials: CY
authors.lastname: Hsu
authors.affiliation: Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Yi-Hsiang
authors.initials: YH
authors.lastname: Huang
authors.affiliation: Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.|Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: Chien-Wei
authors.initials: CW
authors.lastname: Su
authors.affiliation: Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.|Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: Han-Chieh
authors.initials: HC
authors.lastname: Lin
authors.affiliation: Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.|Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: Rheun-Chuan
authors.initials: RC
authors.lastname: Lee
authors.affiliation: Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.|Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: Jen-Huey
authors.initials: JH
authors.lastname: Chiang
authors.affiliation: Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan. tihuo@vghtpe.gov.tw.|Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan. tihuo@vghtpe.gov.tw.
authors.forename: Teh-Ia
authors.initials: TI
authors.lastname: Huo
authors.affiliation: Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.|Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: Shou-Dong
authors.initials: SD
authors.lastname: Lee