Prognostic indicators for transarterial chemoembolization in patients with hepatocellular carcinoma with extrahepatic spread identified

1. In a retrospective study of 111 patients with hepatocellular carcinoma (HCC) with extrahepatic spread (EHS) treated with transarterial chemoembolization (TACE), median overall survival was 3.8 months.

2. Maximum tumor size ≥10 cm, the presence of multifocal intrahepatic tumors, and portal vein tumor thrombosis were elucidated as indicators of poor prognosis.

Evidence Rating Level: 3 (Average)   

Study Rundown: Advanced HCC is associated with poor outcomes and median overall survival of 6 to 20 months. In HCC patients with EHS, previous studies have demonstrated that intrahepatic tumor burden is a poor prognostic indicator for disease progression and overall patient survival. Thus, treatments such as TACE, which specifically target intrahepatic lesions, may improve survival. The objective of the present study was to evaluate treatment outcomes of TACE in patients with HCC and EHS and to establish prognostic factors to select the optimal candidates for treatment.

This study retrospective evaluated the use of TACE with doxorubicin in 111 patients with HCC and EHS. At the conclusion of the study, the median overall survival was 3.8 months. Maximum tumor size ≥10 cm, the presence of multifocal intrahepatic tumors, and portal vein tumor thrombosis (PVTT), were elucidated as indicators of poor prognosis. These findings demonstrate that TACE is most likely not an optimal therapy in this subset of patients, but may benefit patients with lower intrahepatic tumor burden. Strengths of this study include the exclusion of patients who were undergoing other simultaneous therapies. However, limitations include the study’s retrospective nature, short-term follow-up duration, and lack of control group for comparison. Larger, prospective, multicenter trials that compare TACE to sorafenib may provide more robust conclusions.

Click to read the study in JVIR

Relevant Reading: Sorafenib therapy for hepatocellular carcinoma with extrahepatic spread: Treatment outcome and prognostic factors

In-Depth [retrospective cohort]: This study retrospectively evaluated TACE with doxorubicin in 111 patients with HCC and EHS at a single center in China. Patients were diagnosed according to the criteria of the European Association for the Study of Liver Disease and American Association for the Study of Liver Disease guidelines, and EHS was determined using imaging and/or pathology. Median overall survival was 3.8 months (95%CI: 2.9–4.7 months). Multivariate analysis demonstrated that maximum tumor size ≥10 cm (HR 1.58; 95%CI: 1.02 to 2.46; p = 0.041), intrahepatic tumor distribution (HR 1.55; 95%CI: 1.03 to 2.33; p = 0.037), and PVTT (HR 1.81; 95%CI: 1.12 to 2.91; p = 0.015) were poor prognostic factors. Intrahepatic tumor size ≥10 cm was associated with significantly shorter overall survival compared to <10 cm (2.6 months vs. 6.0 months, p < 0.001).

Image: CC/Wiki/Ed Uthman

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