Severity and Timing of Progression Predict Refractoriness to Transarterial Chemoembolization in Hepatocellular Carcinoma
Journal of Gastroenterology and Hepatology,  Clinical Article

Kim HY et al. – Stage progression (SP)–free survival can be regarded as an endpoint for transarterial chemoembolization (TACE) refractoriness. Development of progression or need for three sessions of TACE within the first 6 months could be predictive of TACE refractoriness.

Methods
  • The authors evaluated 264 patients with intermediate-stage HCC who underwent TACE between January 2006 and September 2009.
  • They designated the development of vascular invasion or extrahepatic spread during follow-up as “stage progression (SP)”, and hypothesized that SP might be the surrogate endpoint for TACE refractoriness.

Results
  • The median follow-up was 18.2 months, and median number of TACE was 3.0 (range, 1-13).
  • Median time-to-progression was 5.5 months (95% confidence interval (CI), 4.8-6.2), and median overall survival was 25.3 months (95% CI, 21.6-29.0).
  • They classified the patients according to disease course as: no progressive disease (PD(-); n=33); PD without SP (PD(+)SP(-); n=113); PD followed by SP (PD --> SP; n=47); and simultaneous PD and SP (PD&SP; n=64).
  • PD(-) and PD(+)SP(-) groups showed no difference in overall survival, PD-->SP group had worse overall survival than PD(-) and PD(+)SP(-) groups, and PD&SP group had the worst overall survival.
  • The significant prognostic factors for SP-free survival were development of PD and need for three sessions of TACE during the first 6 months.

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