Certain Patients With Extrahepatic Spread May Benefit From Chemoembolization
Maximum tumor size, intrahepatic tumor distribution, and the presence of portal vein tumor thrombosis (PVTT) are useful factors in predicting the likelihood of overall survival for patients with hepatocellular carcinoma (HCC) and extrahepatic spread (EHS). Researchers reported their findings in the Journal of Vascular and Interventional Radiology.
The retrospective study included 111 consecutive patients who were treated from January 2010 to June 2014 in a single center. The patients had HCC and EHS and received treatment by transarterial chemoembolization alone.
Patients were followed up for a median of 3.8 months, with a median overall survival rate of 3.8 months. Using Cox regression analysis, the study’s authors calculated factors linked with overall survival. Multivariate analysis indicated that a maximum tumor size ≥ 10 cm (hazard ratio [HR] 1.58; 95% confidence interval, 1.02-2.46) significantly predicts overall survival. Multifocal intrahepatic tumors (HR 1.55; 95% CI, 1.03-2.33) and PVTT (HR 1.81; 95% CI, 1.12-2.91) were also significant independent predictors of overall survival.
Using these data, the researchers developed a scoring equation to predict the outcome of treatment with transarterial chemoembolization, with an area under the receiver operating curve of 0.76 in predicting 6-month survival. A cut-off score of 5.5 was chosen to ensure the best sensitivity and specificity, and patients with HCC and EHS were categorized into 2 groups that had significant differences in overall survival. Individuals in the EHS1 group had a risk score of less than 5.5 and an overall survival of 8.1 months, while those in the EHS2 group had a risk score ≥ 5.5 and an overall survival of 2.4 months.
“Transarterial chemoembolization may provide a survival benefit in selected patients with EHS who have a limited intrahepatic tumor volume. The risk score described in this article may be helpful in selecting patients who may benefit from such locoregional treatment,” the researchers concluded.
Wang E, Liu L, Dongdong X, et al. Chemoembolization for hepatocellular carcinoma in patients with extrahepatic spread: prognostic determinants and appropriate candidates. J Vasc Interv Radiol. 2017. 28(7):956-962.