Perfusion and parenchymal changes related to vascular alterations of the liver

Clinical outcomes of transarterial chemoembolization in Child-Turcotte Pugh class A patients with a single small (≤3 cm) hepatocellular carcinoma

BACKGROUND AND AIM

Transarterial chemoembolization (TACE) is one of the standard modalities used to treat unresectable hepatocellular carcinoma (HCC), but the effectiveness of TACE for treating patients with a solitary small (≤3 cm) HCC and well-preserved liver function has not been definitively established. This study aimed to determine the therapeutic impact of TACE in patients with these characteristics.

METHODS

This multicenter (four university hospitals) retrospective cohort study analyzed the medical records of 250 patients with a solitary small (≤3 cm) HCC and Child-Turcotte-Pugh (CTP) class A liver function diagnosed over 10 years. Posttreatment outcomes, including overall survival (OS), recurrence-free survival (RFS), and adverse events, were assessed following TACE therapy.

RESULTS

One hundred and thirty-eight of the 250 patients (55.2%) treated with TACE achieved complete remission (CR). Overall median OS was 77.7 months, and median OS was significantly longer in the CR group than in the non-CR group (89.1 vs. 58.8 months, P = 0.001). Median RFS was 19.1 months in the CR group. Subgroup analysis identified hypertension, an elevated serum albumin level, and achieving CR as significant positive predictors of OS, whereas diabetes, hepatitis c virus infection, and tumor size (>2 cm) were poor prognostic factors of OS.

CONCLUSIONS

The study demonstrates the effectiveness of TACE as a viable alternative for treating solitary small (≤3 cm) HCC in CTP class A patients.

Assessment of the relationship between hepatocellular carcinoma location and its response to transarterial chemoembolization

Background

Transarterial chemoembolization (TACE) is the recommended treatment in intermediate stage of hepatocellular carcinoma (HCC). Many indices are used to predict the outcome of the TACE. The location of the HCC has not been enough studied as a prognostic variable.

Results

We evaluated 149 HCC nodules (111 patients) and analyzed the association between the response to TACE and the nodule location. There was a significant difference between the complete response (CR) and the non-CR group in the location of the HCC regarding its segment and the response to TACE with the anterior segment lesions achieving higher rates of complete response (CR) (P .03), and the distance between the tumor and the liver capsule with the subcapsular lesions showing higher rate of non-CR (P .02). However, there was no significant difference between the CR and the non-CR groups regarding the location between the right and the left lobes (P .48) and the central versus peripheral lesions (P .41).

Conclusions

The location of the HCC can improve the prediction of the tumor response to TACE. Anterior segment tumors showed a higher rate of complete response and subcapsular lesions showed a higher rate of recurrence after TACE.

Evaluation of the relationship between hepatocellular carcinoma location and transarterial chemoembolization efficacy

AIM

To evaluate the relationship between the location of hepatocellular carcinoma (HCC) and the efficacy of transarterial chemoembolization (TACE).

METHODS

We evaluated 115 patients (127 nodules), excluding recurrent nodules, treated with TACE between January 2011 and June 2014. TACE efficacy was evaluated according to mRECIST. The HCC location coefficient was calculated as the distance from the central portal portion to the HCC center (mm)/liver diameter (mm) on multiplanar reconstruction images rendered (MPR) to visualize bifurcation of the right and left branches of the portal vein and HCC center. The HCC location coefficient was compared between complete response (CR) and non-CR groups in Child-Pugh grade A and B patients.

RESULTS

The median location coefficient of HCC among all nodules, the right lobe, and the medial segment was significantly higher in the CR group than in the non-CR group in the Child-Pugh grade A patients (0.82 vs 0.62, P < 0.001; 0.71 vs 0.59, P < 0.01; 0.81 vs 0.49, P < 0.05, respectively). However, there was no significant difference in the median location coefficient of the HCC in the lateral segment between in the CR and in the non-CR groups (0.67 vs 0.65, P > 0.05). On the other hand, in the Child-Pugh grade B patients, the HCC median location coefficient in each lobe and segment was not significantly different between in the CR and in the non-CR groups.

CONCLUSION

Improved TACE efficacy may be obtained for HCC in the peripheral zone of the right lobe and the medial segment in Child-Pugh grade A patients.