title: Does the Degree of Hepatocellular Carcinoma Tumor Necrosis following Transarterial Chemoembolization Impact Patient Survival?
abstract: Purpose. The association between transarterial chemoembolization- (TACE-) induced HCC tumor necrosis measured by the modified Response Evaluation Criteria In Solid Tumors (mRECIST) and patient survival is poorly defined. We hypothesize that survival will be superior in HCC patients with increased TACE-induced tumor necrosis. Materials and Methods. TACE interventions were retrospectively reviewed. Tumor response was quantified via dichotomized (responders and nonresponders) and the four defined mRECIST categories. Results. Median survival following TACE was significantly greater in responders compared to nonresponders (20.8 months versus 14.9 months, p = 0.011). Survival outcomes also significantly varied among the four mRECIST categories (p = 0.0003): complete, 21.4 months; partial, 20.8; stable, 16.8; and progressive, 7.73. Only progressive disease demonstrated significantly worse survival when compared to complete response. Multivariable analysis showed that progressive disease, increasing total tumor diameter, and non-Child-Pugh class A were independent predictors of post-TACE mortality. Conclusions. Both dichotomized (responders and nonresponders) and the four defined mRECIST responses to TACE in patients with HCC were predictive of survival. The main driver of the survival analysis was poor survival in the progressive disease group. Surprisingly, there was small nonsignificant survival benefit between complete, partial, and stable disease groups. These findings may inform HCC treatment decisions following first TACE.
authors.affiliation: University of Alabama at Birmingham School of Medicine, Birmingham, AL 35233, USA.
authors.forename: Nathan
authors.initials: N
authors.lastname: Haywood
authors.affiliation: University of Alabama at Birmingham School of Medicine, Birmingham, AL 35233, USA.
authors.forename: Kyle
authors.initials: K
authors.lastname: Gennaro
authors.affiliation: University of Alabama at Birmingham School of Medicine, Birmingham, AL 35233, USA.
authors.forename: John
authors.initials: J
authors.lastname: Obert
authors.affiliation: University of Alabama at Birmingham School of Medicine, Birmingham, AL 35233, USA.
authors.forename: Paul F
authors.initials: PF
authors.lastname: Sauer
authors.affiliation: Biostatistics Division, School of Public Health, University of Alabama at Birmingham, Birmingham, AL 35233, USA.
authors.forename: David T
authors.initials: DT
authors.lastname: Redden
authors.affiliation: Department of Radiology, University of Alabama at Birmingham, Birmingham, AL 35233, USA.
authors.forename: Jessica
authors.initials: J
authors.lastname: Zarzour
authors.affiliation: Department of Radiology, University of Alabama at Birmingham, Birmingham, AL 35233, USA.
authors.forename: J Kevin
authors.initials: JK
authors.lastname: Smith
authors.affiliation: Department of Radiology, University of Alabama at Birmingham, Birmingham, AL 35233, USA.
authors.forename: David
authors.initials: D
authors.lastname: Bolus
authors.affiliation: Department of Radiology, University of Alabama at Birmingham, Birmingham, AL 35233, USA.
authors.forename: Souheil
authors.initials: S
authors.lastname: Saddekni
authors.affiliation: Department of Radiology, University of Alabama at Birmingham, Birmingham, AL 35233, USA.
authors.forename: Ahmed Kamel Abdel
authors.initials: AK
authors.lastname: Aal
authors.affiliation: Liver Transplant and Hepatobiliary Surgery, University of Alabama at Birmingham, Birmingham, AL 35233, USA.
authors.forename: Stephen
authors.initials: S
authors.lastname: Gray
authors.affiliation: Liver Transplant and Hepatobiliary Surgery, University of Alabama at Birmingham, Birmingham, AL 35233, USA.
authors.forename: Jared
authors.initials: J
authors.lastname: White
authors.affiliation: Liver Transplant and Hepatobiliary Surgery, University of Alabama at Birmingham, Birmingham, AL 35233, USA.
authors.forename: Devin E
authors.initials: DE
authors.lastname: Eckhoff
authors.affiliation: Liver Transplant and Hepatobiliary Surgery, University of Alabama at Birmingham, Birmingham, AL 35233, USA.
authors.forename: Derek A
authors.initials: DA
authors.lastname: DuBay