Radiological Response and Characteristics of Patients Diagnosed With Hepatocellular Carcinoma Undergoing Transarterial Chemoembolization: An Observational Study.

Abstract

Introduction: Hepatocellular carcinoma (HCC), commonly associated with cirrhosis and factors such as viral hepatitis and metabolic disorders, is often diagnosed at advanced stages, influencing survival. Transarterial chemoembolization (TACE) is a primary therapeutic approach aimed at prolonging survival or serving as a link to liver transplantation. Objective: To identify factors associated with the response to TACE by modified Response Evaluation Criteria in Solid Tumors (mRECIST) in patients with HCC. Materials and Methods: This is a retrospective cohort study conducted at a Liver Institute in Brazil, including patients with HCC at Stages A and B treated with TACE from January 2011 to December 2021. Data were collected from electronic or digitized physical medical records and included demographic, clinical-laboratory, and tumor-related variables. Radiological response was assessed using mRECIST criteria. Statistical analysis encompassed various tests, with a significance level of 5%. Results: Seventy-six patients were evaluated, the majority being male (67.1%), with a median age of 62 years (57.0-70.0). Patients who responded to TACE showed a significant reduction in lesion size (p < 0.001) compared to the nonresponding group, resulting in lesion enlargement (p = 0.047). Only 38.2% of patients showed an objective response after the first TACE, with a trend towards a higher response in patients with stable disease (p < 0.001). Hepatitis C virus (HCV) etiology was associated with a higher chance of treatment response (p = 0.032). Initial disease staging was characterized by single tumors, while intermediate staging presented larger tumors after TACE. Conclusion: The association between HCV-induced cirrhosis and a better response to TACE underscores the importance of assessing liver function status in determining therapeutic response. No association was identified between pre-TACE alpha-fetoprotein levels and a higher likelihood of radiological response.