Target lesion response predicts survival of patients with hepatocellular carcinoma retreated with transarterial chemoembolization.
The discontinuation rules of transarterial chemoembolization (TACE) for patients who were assessed as progressive disease (PD) but stage progression-free (SP-free: still belongs to Barcelona Clinic Liver Cancer B) after TACE are unclear. We aimed to evaluate the impact of the PD-pattern on the survival of these patients retreated with TACE.



In total, 115 consecutive patients who were assessed as PD but SP-free after TACE and then underwent at least one subsequent TACE session were included. Sixty patients were assessed as PD with target lesion progression (TP), and 55 patients were assessed as PD with target lesion non-progression (TNP). Survival and treatment-related adverse events were compared between the two groups. Additional external validation was performed using a data set (n = 103) from another institution.



Patients with TNP had significantly longer median post-progression survival (PPS) than those with TP (21.0 vs. 11.9 months, P = 0.004). After TACE retreatment, the incidence of liver dysfunction was significantly higher for patients with TP than for patients with TNP (45% vs. 20%, P = 0.031). In the multivariate analysis, the target lesion response was one of the most significant prognostic factors for PPS (HR = 2.01; 95% confidence interval: 1.23-3.27; P = 0.005). The findings were supported by an independent external cohort.



Compared to patients with TNP, patients with TP might exhibit no improvement in survival and even present damaged liver function after retreatment with TACE. Target lesion response is useful as a clinical decision for repeated TACE in these patients.
Department of Hepatobiliary Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China.|State Key Laboratory of Oncology in South China, Guangzhou, China.|Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.
Yong-Fa
YF
Zhang
Department of Hepatobiliary Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China.|State Key Laboratory of Oncology in South China, Guangzhou, China.|Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.
Rong-Ping
RP
Guo
Department of Hepatobiliary Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China.|State Key Laboratory of Oncology in South China, Guangzhou, China.|Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.
Han-Yue
HY
OuYang
State Key Laboratory of Oncology in South China, Guangzhou, China.|Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.|Department of Radiology, Sun Yat-sen University Cancer Center, Guangzhou, China.
Jing-Xian
JX
Shen
State Key Laboratory of Oncology in South China, Guangzhou, China.|Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.|Department of Radiology, Sun Yat-sen University Cancer Center, Guangzhou, China.
Jing
J
Zhao
Department of Interventional Radiology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
Guo-Sheng
GS
Tan
Department of Hepatobiliary Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China.|State Key Laboratory of Oncology in South China, Guangzhou, China.|Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.
Yong
Y
Le
Department of Hepatobiliary Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China.|State Key Laboratory of Oncology in South China, Guangzhou, China.|Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.
Wei
W
Wei
Department of Hepatobiliary Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China. shiming@mail.sysu.edu.cn.|State Key Laboratory of Oncology in South China, Guangzhou, China. shiming@mail.sysu.edu.cn.|Collaborative Innovation Center for Cancer Medicine, Guangzhou, China. shiming@mail.sysu.edu.cn.
Ming
M
Shi
D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000401:mortality* / Q000628:therapy*; D016461:Chemoembolization, Therapeutic; D002681:China / Q000453:epidemiology; D018450:Disease Progression; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D015996:Survival Rate; D016896:Treatment Outcome
hepatocellular carcinoma; progressive disease; stage progression-free; target lesion response; transarterial chemoembolization