Patients with hepatocellular carcinoma (HCC) who require multiple transarterial chemoembolization (TACE) treatments in quick succession and prediction of outcome.
Authors: Ouf Mahmoud , Prins Petra , Armstrong Samantha Ann , Singh Bhavana Pendurthi , Geng Xue , Wang Hongkun , Yin Chao , Sadagopan Narayanan , He Aiwu Ruth 
Published: July 2024

e16208

Background: TACE has been one of the standard treatments for intermediate-stage HCC patients for over 20 years. The outcome of patients from TACE treatment is variable as the result of the differences in tumor burden, liver function, and comorbidities. Given the advancement made in systemic therapies for advanced-stage HCC, and emerging data on the combination of TACE and immunotherapy, there is an unmet need to identify patients with intermediate-stage HCC who may benefit from early introduction of systemic therapy. The purpose of the study is to identify clinical factors that predict poorer outcomes in patients who receive TACE treatment. Methods: This retrospective analysis is a single-institutional study involving patients from MedStar Georgetown University Hospital. The investigation includes 167 individuals diagnosed with HCC who underwent TACE from 2007 to 2021. The data compiled for analysis encompassed patient demographics, clinical features, risk factors, and treatment outcomes. The log-rank test is used to test whether there is a difference between the survival times of different groups. Results: 167 HCC patients, with 105 in intermediate/advanced BCLC stages B and C were included. The cohort, with a median age of 62, comprised 128 males and 43 females. Cirrhosis was seen in 83% of patients mostly due to viral etiology. Hepatitis C (58%) and hepatitis B (13%) were common, with 4% having both. The remaining 24% had cirrhosis from metabolic-associated fatty liver disease (MAFLD). The median overall survival (OS) durations for patients in BCLC-A (n = 62), BCLC-B (n = 64), and BCLC-C (n = 41) stages who underwent TACE as a component of their comprehensive treatment strategy were 67.9, 29.7, and 30.6 months, respectively (P = 0.035). In 64 subjects with BCLC stage B disease, patients who received 3 or more TACE treatments had higher OS (43.6 months) than those with two or fewer treatments (25.4 months, P = 0.042). Among the patients who had 2 or fewer TACE treatments, 6 patients had liver decompensation and discontinued treatment and 21 patients developed cancer progression and went on to receive systemic therapy. The median time to progression from the last TACE treatment was 5 months. Interestingly, among the patients who received 3 or more TACE treatments, 10 patients who had 3 or more TACE treatments within 6 months from the 1st TACE treatment had an mOS of 25.8 months while 25 patients who had 3 or more TACE treatments over a time span more than 6 months had a mOS of 49.4 months (P = 0.0186). Conclusions: Rapid disease progression in 6 months from the start of TACE treatment was predictive of aggressive tumor biology, and these patients may benefit from the early introduction to systemic therapy. Molecular biomarkers used to predict aggressive tumor biology are an unmet need for selecting patients to receive the combination of TACE and systemic therapy.