1Department of Internal Medicine; Yonsei Institute of Gastroenterology.
2Department of Internal Medicine; Yonsei Institute of Gastroenterology. Electronic address: firstname.lastname@example.org.
3Department of Radiology, St. Vincent's Hospital, The Catholic University of Korea, Gyeonggi-do, Republic of Korea.
4Department of Radiology, Yonsei University College of Medicine.
5Department of Internal Medicine; Yonsei Institute of Gastroenterology; Brain Korea 21 Project for Medical Science, Seoul, Republic of Korea.
The aim of this study is to evaluate prognostic significances of not only the initial and the best response during repeated trans-arterial chemoembolization (TACE) for hepatocellular carcinoma (HCC), if eligible, but also time-point of achieving treatment responses.
Treatment-naïve 314 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 (>5cm) and multiple (>3) 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 early time-point is still the robust predictor for favorable outcomes.