Severity and timing of progression predict refractoriness to transarterial chemoembolization in hepatocellular carcinoma

Hwi Young Kim, Joong Won Park, Jungnam Joo, Se Jin Jung, Sangbu An, Sang Myung Woo, Hyun Beom Kim, Young Hwan Koh, Woo Jin Lee, Chang Min Kim

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52 Scopus citations


Background and Aim: Patients with hepatocellular carcinoma (HCC) that is refractory to repeated transarterial chemoembolization (TACE) are considered for systemic therapy, but TACE refractoriness is not well defined. The aim of this study was to determine the characteristics of patients whose HCC is refractory to repetitive TACE. Methods: We evaluated 264 patients with intermediate-stage HCC who underwent TACE between January 2006 and September 2009. We designated the development of vascular invasion or extrahepatic spread during follow up as "stage progression" (SP), and hypothesized that SP might be the surrogate end-point for TACE refractoriness. Results: The median follow up was 18.2months, and median number of TACE was 3.0 (range, 1-13). Median time-to-progression was 5.5months (95% confidence interval, 4.8-6.2), and median overall survival was 25.3months (95% confidence interval, 21.6-29.0). We classified the patients according to disease course as: no progressive disease (PD(-); n=33); PD without SP (PD(+)SP(-); n=113); PD followed by SP (PD→SP; n=47); and simultaneous PD and SP (PD&SP; n=64). PD(-) and PD(+)SP(-) groups showed no difference in overall survival, PD→SP group had worse overall survival than PD(-) and PD(+)SP(-) groups, and PD&SP group had the worst overall survival. The significant prognostic factors for SP-free survival were development of PD and need for three sessions of TACE during the first 6months. Conclusions: SP-free survival can be regarded as an end-point for TACE refractoriness. Development of progression or need for three sessions of TACE within the first 6months could be predictive of TACE refractoriness.

Original languageEnglish
Pages (from-to)1051-1056
Number of pages6
JournalJournal of Gastroenterology and Hepatology (Australia)
Issue number6
StatePublished - Jun 2012


  • Chemoembolization
  • Disease progression
  • Liver cancer
  • Response
  • Survival


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