Safety and Efficacy of Transarterial Chemoembolization for Caudate Lobe Hepatocellular Carcinoma: Long-Term Clinical Outcomes.

Purpose: To evaluate the safety and effectiveness of transarterial chemoembolization (TACE) as first-line treatment for single caudate lobe hepatocellular carcinoma (HCC).

Materials and methods: 107 treatment-naive patients who received TACE between 2006 and 2023 as first-line treatment for single caudate lobe HCC were retrospectively evaluated. Adverse events, radiologic tumor response, progression-free survival (PFS), and overall survival (OS) following TACE were investigated. Periprocedural variables related to complete response (CR) and OS were investigated using multivariable regression analyses.

Results: Complete TACE (cisplatin, ethiodized oil and gelatin foam particles) through all tumor-feeding caudate arteries was possible in 73% of the study patients. The severe adverse event rate was 2.8%. A CR at 1 month after TACE was achieved in 67% of the study patients and multivariable analysis showed that complete TACE (P < .001; odds ratio [OR], 42.86) and a single tumor-feeding artery (P = .002; OR, 8.04) were significant predictors of a CR. The median PFS after TACE was 29 months. After TACE, the 3-, 5-, and 10-year OS rates were 62%, 46%, and 33%, respectively, and the median OS was 53 months. Multivariable analysis revealed four significant periprocedural risk factors: incomplete TACE (P = .004; hazard ratio [HR], 2.69), multiple tumor-feeding arteries (P = .04; HR, 2.02), Child-Pugh class B (P = .003; HR, 2.91), and advanced stage HCC (P = .02; HR, 3.43).

Conclusions: TACE appears to be a safe and potentially effective first-line treatment option, with long PFS, for patients with single HCC located in the caudate lobe.