title: Radiologic response to transcatheter hepatic arterial chemoembolization and clinical outcomes in patients with hepatocellular carcinoma.
abstract: OBJECTIVE
  The current study analysed the association between radiologic tumour response and survival times of patients with hepatocellular carcinoma (HCC) who were treated with transcatheter hepatic arterial chemoembolization (TACE).
  
  
  METHODS
  Among 493 consecutive patients presenting to our institution between July 2002 and June 2010 with radiologically (n = 398) or histologically (n = 95) confirmed HCC, 368 patients who met inclusion criteria, underwent TACE and had confirmed survival data were retrospectively reviewed. The radiologic response was assessed using RECIST 1.1, EASL and mRECIST criteria at 1 month after the initial TACE.
  
  
  RESULTS
  By univariate analysis, higher Child-Turcotte-Pugh (CTP) score, bilobar and multifocal distribution of tumours, larger tumour size (>5 cm), higher serum alpha-foetoprotein (AFP) level (>200 ng/ml), no subsequent radiofrequency ablation, advanced ECOG, UNOS and BCLC staging, absence of complete necrosis and non-responder (SD or PD) in RECIST 1.1, EASL and mRECIST response assessment were significantly associated with shorter overall survival times. By Cox proportional hazards model, advanced age, presence of ascites, higher MELD score, advanced BCLC staging, absence of complete necrosis and non-responder by RECIST 1.1, EASL and mRECIST criteria were independent and significant prognosticators for overall survival times in patients with HCC who underwent TACE. By time-dependent ROC curve analysis, mRECIST response criteria showed greatest accuracy in predicting survival (AUROC = 0.8676), followed by EASL (AUROC = 0.8471) and RECIST 1.1 (AUROC = 0.7986).
  
  
  CONCLUSIONS
  mRECIST and EASL criteria for assessing radiologic response 1 month after initial TACE more consistently predict the differences in overall survival between responders and non-responders than conventional RECIST 1.1 criteria.
authors.affiliation: Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University, Seoul, Korea.
authors.forename: Chang Joon
authors.initials: CJ
authors.lastname: Kim
authors.forename: Hong Joo
authors.initials: HJ
authors.lastname: Kim
authors.forename: Jung Ho
authors.initials: JH
authors.lastname: Park
authors.forename: Dong Il
authors.initials: DI
authors.lastname: Park
authors.forename: Yong Kyun
authors.initials: YK
authors.lastname: Cho
authors.forename: Chong Il
authors.initials: CI
authors.lastname: Sohn
authors.forename: Woo Kyu
authors.initials: WK
authors.lastname: Jeon
authors.forename: Byung Ik
authors.initials: BI
authors.lastname: Kim
authors.forename: Min-Ji
authors.initials: MJ
authors.lastname: Kim
mesh_terms: D000367:Age Factors; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging* / Q000473:pathology / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000379:methods*; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D007261:Infusions, Intra-Arterial / Q000379:methods; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012372:ROC Curve; D011859:Radiography; D056910:Republic of Korea; D016019:Survival Analysis; D016896:Treatment Outcome
keywords: Complete necrosis; hepatocellular carcinoma; radiologic response; transcatheter hepatic arterial chemoembolization