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Recurrence of Hepatocellular Carcinoma After Complete Radiologic Response to Trans-Arterial Embolization: A Retrospective Study on Patterns, Treatments, and Prognoses

  • Hepatobiliary Tumors
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Abstract

Background

There is limited information about the long-term outcomes and patterns of progression in patients who have unresectable, liver-confined hepatocellular carcinoma (HCC) with complete response (CR) to transarterial embolization and do not undergo resection or transplantation (LT).

Methods

A retrospective review analyzed participants in a randomized trial comparing hepatic artery embolization (HAE) and drug-eluting bead transarterial chemoembolization (DEB-TACE) with doxorubicin who had CR according to modified response evaluation criteria in solid tumors (mRECIST). The overall survival (OS), incidence and patterns of progression, and factors associated with progression were assessed.

Results

Of the 101 patients in the trial, 37 with CR were included in this study. This cohort had 17 patients treated with HAE (46 %), and 20 patients managed with DEB-TACE (54 %). The median age was 67 years (range, 42–82 years). Most of the cohort were male (86.5 %) and Caucasian (78 %). The median pre-treatment Model for End-Stage Liver Disease (MELD) score was 10, and 70 % of the cohort had Barcelona Clinic Liver Cancer (BCLC) stage B or C. The median follow-up period was 49 months (95 % confidence interval [CI], 9–108 months), and the median OS was 25 months (95 % CI, 18.9–30.9 months). The 3- and 5-year survival rates were respectively 31 % (95 % CI, 16.7–45.9 %) and 18 % (95 % CI, 6.8–32.1 %). The 1- and 2-year cumulative incidences of progression were respectively 76 % (95 % CI, 57.7–86.8 %) and 92 % (95 % CI, 74.5–97.6 %). The most common first site of progression was the previously treated hepatic site or local site (32 %, 12/37). The 3-year cumulative incidence of progression was 65 % (95 % CI, 46.4–78.4 %) for the local site.

Conclusion

Patients with advanced-stage HCC and CR to embolization do not have durable responses and experience inevitable disease progression. Most patients with progression have liver-confined disease and should be evaluated for additional consolidative treatments.

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Acknowledgment

This research was funded in part through the NIH/NCI Cancer Center Support Grant P30 CA008748.

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Authors and Affiliations

  1. Hepatopancreatobiliary Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Crisanta H. Ilagan MD, Vinod P. Balachandran MD, Jeffrey A. Drebin MD, PhD, William R. Jarnagin MD, Alice C. Wei MD, MSc, T. Peter Kingham MD & Michael I. D’Angelica MD, FACS

  2. Department of Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Debra A. Goldman MS & Mithat Gönen PhD

  3. Department of Surgery, New York Presbyterian–Weill Cornell Medical Center, New York, NY, USA

    Victoria G. Aveson MD

  4. The Oregon Clinic Gastrointestinal and Minimally Invasive Surgery, Portland, OR, USA

    Michelle Babicky MD

  5. Weill Medical College at Cornell University, New York, NY, USA

    Vinod P. Balachandran MD, Jeffrey A. Drebin MD, PhD, William R. Jarnagin MD, Alice C. Wei MD, MSc, T. Peter Kingham MD, Ghassan K. Abou-Alfa MD & Michael I. D’Angelica MD, FACS

  6. Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Ghassan K. Abou-Alfa MD

  7. Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, USA

    Karen T. Brown MD

Authors
  1. Crisanta H. Ilagan MD
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Contributions

Conception or design of the work: All authors. Acquisition, analysis, or interpretation of data: Ilagan, Aveson, Babicky, Goldman, Brown, D’Angelica. Drafting of the work: Ilagan, D’Angelica. Critical revision for important intellectual content: All authors. Drs. D’Angelica, Brown, and Ilagan had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis

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Correspondence to Michael I. D’Angelica MD, FACS.

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Disclosure

Ghassan K. Abou-Alfa reports research support from Arcus, Agios, Astra Zeneca, BioNtech, BMS, Celgene, Flatiron, Genentech/Roche, Genoscience, Incyte, Polaris, Puma, QED, Silenseed, and Yiviva, as well as consulting support from Adicet, Alnylam, Astra Zeneca, Autem, Bayer, Beigene, Berry Genomics, Celgene, Cend, CytomX, Eisai, Eli Lilly, Exelixis, Flatiron, Genentech/Roche, Genoscience, Helio, Incyte, Ipsen, Legend Biotech, Merck, Nerviano, QED, Redhill, Rafael, Servier, Silenseed, Sobi, Surface Oncology, Therabionics, Vector, and Yiviva (PCT/US2014/031545 filed on 24 March 2014, and priority application serial no. 61/804,907 filed 25 March 2013. Debra A. Goldman is a current employee of Regeneron Pharmaceuticals and receives restricted stock as a form of compensation. Alice C. Wei reports consulting for Histosonics, Biosapien; honorarium for teaching for Medtronic and AstraZeneca; and travel for Intuitive Surgical and Bayer. The remaining authors have no conflicts of interest.

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Ilagan, C.H., Goldman, D.A., Gönen, M. et al. Recurrence of Hepatocellular Carcinoma After Complete Radiologic Response to Trans-Arterial Embolization: A Retrospective Study on Patterns, Treatments, and Prognoses. Ann Surg Oncol 29, 6815–6826 (2022). https://doi.org/10.1245/s10434-022-12036-8

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