Can Adjuvant TACE Improve Outcomes in Patients with HCC and Microvascular Invasion?
Adjuvant transarterial chemoembolization (TACE) was associated with improved outcomes in patients with hepatocellular carcinoma (HCC) and microvascular invasion (mVI) but tumor size affected efficacy, according to a study published in the Oncologist.
A crude cohort was retrospectively assembled including 549 patients with HCC and mVI. After utilizing an adopted propensity score matching method, another cohort of 444 patients with similar baseline characteristics was assembled. Stratified analyses and multivariate Cox analyses were used to asses the affects of adjuvant TACE in the 2 cohorts.
With respect to overall survival (OS), there was significant correlation between tumor size and adjuvant TACE (P = 0.006 for interaction).
Patients in the matched cohort who received adjuvant TACE had higher 5-year OS rates (72.4% vs 50.9%, P = 0.005) and 5-year recurrence-free survival (50.5% vs 36.4%, P = 0.003) in the subgroup of patients with tumors ≤5 cm (32.3% vs 24.9%, P = 0.350 and 18.8% vs 19.7%, P = 0.180). The independent protective role of adjuvant TACE on OS was observed in patients with tumor ≤5 cm (adjusted odds ratio [OR] = 0.59, 95% confidence interval [CI] 0.36-0.97) but not in patients with tumor >5 cm (adjusted OR = 1.17, 95% CI 0.84-1.62).
The authors concluded that adjuvant TACE was associated with improved outcomes in patients with HCC and mVI, but not in patients with tumors >5 cm.
“The outcomes of patients with hepatocellular carcinoma and microvascular invasion who received adjuvant transarterial chemoembolization were inconsistent in this study. According to the current protocol, adjuvant transarterial chemoembolization was associated with improved prognosis in patients with microvascular invasion, except for those with tumor >5 cm. Multivariate Cox models confirmed adjuvant transarterial chemoembolization was an independent protective factor in the tumor ≤5 cm subgroup but not in the tumor >5 cm subgroup,” the authors said.
Liu S, Li H, Guo L, et al. Tumor size affects efficacy of adjuvant transarterial chemoembolization in patients with hepatocellular carcinoma and microvascular invasion. Oncologist. 2018;pii: theoncologist.2018-0305. doi: 10.1634/theoncologist.2018-0305. [Epub ahead of print].