Purpose: Finding a feeding vessel with diameter greater than 0.9 mm on transcatheter chemoembolization (TACE) angiogram for hepatocellular cancer (HCC) has been shown to predict tumor necrosis on subsequent pathology. However, whether this finding can translate into a useful clinical predictor for post-chemoembolization response and survival is unknown. This study aimed to determine whether the presence of an arterial feeder vessel on pre-TACE cross-sectional imaging is associated with treatment response and survival after TACE for HCC.
Material and Methods: After IRB approval, a retrospective medical record search for all TACE procedures performed for HCC from 2015-2016 yielded 138 patients that underwent 275 TACE sessions spanning 2011 to 2017. Patients consisted of 98 males (71%), mean age of 62 (r, 37-86), with each patient undergoing 1-5 TACE sessions. Endpoints included target lesion response and overall treatment response, defined by the mRECIST criteria, as well as patient survival. Pre-procedural liver MRI was reviewed for presence of arterial feeder. Multilevel logistic regressions and Cox regressions were used to assess the effects of arterial feeder presence on treatment response and patient survival, respectively, adjusting for other covariates.
Results: Overall treatment response (complete and partial) was seen in 53% of TACE treatments in 69% of patients. Arterial feeder was present on pre-procedural cross-sectional imaging in 28% of TACE sessions. Median survival for all patients was 26.5 months (Q1-3, 13.2-38.1). The presence of arterial feeder led to better target lesion response (OR = 11.9, p < 0.0001), overall treatment response (OR = 9.3, p < 0.0001), and improved survival (HR = 0.55, p = 0.02). - Corresponding tables have been uploaded (1-3)
Conclusions: The presence of an arterial feeder on pre-TACE cross-sectional imaging is associated with target lesion response, overall treatment response, and survival after TACE. Further research is warranted to verify these findings.