title: Computed tomography predictors of hepatocellular carcinoma tumour necrosis after chemoembolization.
abstract: BACKGROUND
  Radiographical features associated with a favourable response to trans-arterial chemoembolization (TACE) are poorly defined for patients with hepatocellular carcinoma (HCC).
  
  
  METHODS
  From 2008 to 2012, all first TACE interventions for HCC performed at the University of Alabama at Birmingham (UAB) were retrospectively reviewed. Only patients with a pre-TACE and a post-TACE computed tomography (CT) scan were included in the analyses (n = 115). HCC tumour response to TACE was quantified via the the modified Response Evaluation Criteria in Solid Tumors (mRECIST) criteria. Univariate and multivariable analyses were constructed.
  
  
  RESULTS
  The index HCC tumours experienced a > 90% or complete tumour necrosis in 59/115 (51%) of patients after the first TACE intervention. On univariate analysis, smaller tumour size, peripheral tumour location and arterial enhancement were associated with a > 90% or complete tumour necrosis, whereas, only smaller tumour size [odds ratio (OR) 0.62; 95% confidence interval (CI) 0.48, 0.81] and peripheral location (OR 6.91; 95% CI 1.75, 27.29) were significant on multivariable analysis. There was a trend towards improved survival in the patients that experienced a > 90% or complete tumour necrosis (P = 0.08).
  
  
  CONCLUSIONS
  Peripherally located smaller HCC tumours are most likely to experience a > 90% or complete tumour necrosis after TACE. Surprisingly, arterial-phase enhancement and portal venous-phase washout were not significantly predictive of TACE-induced tumour necrosis. The TACE response was not statistically associated with improved survival.
authors: Liver Transplant and Hepatobiliary Surgery, University of Alabama at Birmingham, Birmingham, AL, USA.
authors: Mary K
authors: MK
authors: Bryant
authors: David P
authors: DP
authors: Dorn
authors: Jessica
authors: J
authors: Zarzour
authors: J Kevin
authors: JK
authors: Smith
authors: David T
authors: DT
authors: Redden
authors: Souheil
authors: S
authors: Saddekni
authors: Ahmed Kamel
authors: AK
authors: Abdel Aal
authors: Stephen H
authors: SH
authors: Gray
authors: Devin E
authors: DE
authors: Eckhoff
authors: Derek A
authors: DA
authors: Dubay
mesh_terms: D000407:Alabama; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging* / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D016461:Chemoembolization, Therapeutic; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D015999:Multivariate Analysis; D009336:Necrosis; D016017:Odds Ratio; D018579:Patient Selection; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D016896:Treatment Outcome
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