Purpose: Transarterial chemoembolization (TACE) is a well-established treatment method for hepatocellular carcinoma (HCC) patients. Although TACE is considered palliative, it often results in a complete response (CR) radiologically. However, little data is available to determine what percentage of patients will have local tumor recurrence following the achievement of a CR radiologically when utilizing modern treatment techniques in a North American subset. The goal of this retrospective review was to determine the frequency with which local recurrence occurs following CR radiologically; what factors may predict this outcome.
Material and Methods: After IRB approval, all patients who underwent TACE for HCC at a single center between 1/1/2011 and 12/31/2016 were retrospectively reviewed. Of these, 150 patients underwent treatment for 230 lesions that achieved a CR radiologically. The group consisted of 26.7% (40/150) women and 73.3% (110/150) men with an average age of 62 ± 6.8 years. The follow up imaging was performed at 1 month then every 3 months for the first year, then every 6 months after the first year if no evidence of residual or recurrent disease was found. If patients were listed for transplant, imaging occurred every 3 months, and patients’ data was censored for transplantation.
Results: Of the 230 lesions, 105 (45.7%) experienced local recurrence at an average of 277.6 days ± 313.4 days. The patients who did not incur radiologic recurrence had a significantly lower number of treatments required to reach CR (1.1 ± 0.33 vs 1.56 ± 0.78, p<0.001). The selectivity of TACE delivery in those who did not recur was sub-segmental in 33.6% (42/125), segmental in 44.8% (56/125), greater than segmental but less than lobar in 11.2% (14/125), and lobar in 10.4% (13/125). The selectivity of TACE delivery in those who did recur was sub-segmental in 42.9% (45/105), segmental in 35.2% (37/105), greater than segmental but less than lobar in 18.1% (19/105), and lobar in 3.8% (4/105). The two groups differed significantly in the selectivity (p=0.049). The size of lesions did not significantly differ between those that did not suffer recurrence (2.6 ± 1.6 cm) and those that did (2.8 ± 1.5 cm) (p=0.13).
Conclusions: A significant portion of HCCs which achieve a complete radiologic response will suffer recurrence. Selectivity of treatment and number of treatments required to achieve a complete radiologic response may be predictive of recurrence.