title: Complete response at first chemoembolization is still the most robust predictor for favorable outcome in hepatocellular carcinoma.
abstract: The aim of this study is to evaluate the prognostic significances of not only the initial and the best response during repeated transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC), but if eligible, also the time point of achieving treatment responses.
  
  
  
  Three hundred and fourteen treatment-naïve patients with well-preserved liver function undergoing TACE were recruited. Treatment responses were assessed using modified Response Evaluation Criteria in Solid Tumors. Overall survival (OS) was analyzed using Kaplan-Meier methods, and Cox regression analysis was performed for multivariate analysis.
  
  
  
  After adjusting other variables, objective response (complete response [CR] and partial response [PR]) as the initial response (adjusted hazard ratio [HR] 0.410) and the best response (adjusted HR 0.335) had independent prognostic significances for OS, respectively (both p < 0.001). Objective responders as the initial response had the longest OS, followed by patients who subsequently achieved objective response after at least two sessions and those who did not achieve objective response during treatment course eventually (52.6, 27.0, and 10.8 months, respectively; log-rank test, p < 0.001). Likewise, patients with CR as the initial response had the longest OS, followed by those who subsequently achieved CR after at least two sessions and those who achieved PR as the best response (70.2, 40.6, and 23.0 months, respectively; log-rank test, p < 0.001). Large (>5 cm) and multiple (⩾ 4) tumors were independently associated with failure to achieve CR after the initial TACE (both p < 0.05).
  
  
  
  Both the initial and the best response predicts OS effectively. However, achievement of treatment response at an early time point is still the most robust predictor for favorable outcomes.
authors: Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea; Yonsei Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors: Beom Kyung
authors: BK
authors: Kim
authors: Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea; Yonsei Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Republic of Korea. Electronic address: ksukorea@yuhs.ac.
authors: Seung Up
authors: SU
authors: Kim
authors: Department of Radiology, St. Vincent's Hospital, The Catholic University of Korea, Gyeonggi-do, Republic of Korea.
authors: Kyung Ah
authors: KA
authors: Kim
authors: Department of Radiology, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors: Yong Eun
authors: YE
authors: Chung
authors: Department of Radiology, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors: Myeong-Jin
authors: MJ
authors: Kim
authors: Department of Radiology, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors: Mi-Suk
authors: MS
authors: Park
authors: Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea; Yonsei Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors: Jun Yong
authors: JY
authors: Park
authors: Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea; Yonsei Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors: Do Young
authors: DY
authors: Kim
authors: Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea; Yonsei Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Republic of Korea; Brain Korea 21 Project for Medical Science, Seoul, Republic of Korea.
authors: Sang Hoon
authors: SH
authors: Ahn
authors: Department of Radiology, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors: Man Deuk
authors: MD
authors: Kim
authors: Department of Radiology, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors: Sung Il
authors: SI
authors: Park
authors: Department of Radiology, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors: Jong Yoon
authors: JY
authors: Won
authors: Department of Radiology, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors: Do Yun
authors: DY
authors: Lee
authors: Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea; Yonsei Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Republic of Korea; Brain Korea 21 Project for Medical Science, Seoul, Republic of Korea.
authors: Kwang-Hyub
authors: KH
authors: Han
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000379:methods*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D011169:Portal Vein / Q000473:pathology; D011379:Prognosis; D016016:Proportional Hazards Models; D012074:Remission Induction
keywords: Best response; Chemoembolization; Hepatocellular carcinoma; Initial response; Prognosis