Long term recurrence analysis post drug eluting bead (deb) chemoembolization for hepatocellular carcinoma (hcc)
Insights
Complete response to drug-eluting beads doxorubicin (DEB-DOX) in hepatocellular carcinoma (HCC) offers a good prognosis. However, managing tumor recurrence and preserving liver function are crucial for long-term survival.
Area of Science:
- Hepatology
- Interventional Radiology
- Oncology
Background:
- Hepatocellular carcinoma (HCC) remains a significant global health challenge.
- Drug-eluting beads loaded with doxorubicin (DEB-DOX) offer a transarterial chemoembolization option for HCC.
- Long-term outcomes after complete response to DEB-DOX require further investigation.
Purpose of the Study:
- To evaluate the long-term recurrence and survival rates in HCC patients achieving complete response after initial DEB-DOX treatment.
- To identify prognostic factors influencing survival and recurrence in this patient cohort.
Main Methods:
- Retrospective analysis of 45 HCC patients with complete response (EASL criteria) to initial DEB-DOX.
- Median follow-up of 63 months, assessing overall survival and recurrence-free survival.
- Analysis included patient demographics, lesion characteristics, and treatment details.
Main Results:
- At 5 years, overall survival was 62.2% and recurrence-free survival was 8.9%.
- Tumor progression and liver disease complications were the primary causes of death.
- Child-Pugh class, combined therapy for recurrences, and number of DEB-DOX procedures were significant prognostic factors for 5-year survival.
Conclusions:
- Achieving complete response to DEB-DOX in HCC is associated with a favorable prognosis.
- Effective management of recurrent tumors and preservation of liver function are critical for improving long-term survival in HCC patients treated with DEB-DOX.
Unlabelled:
BACKROUND-AIMS: To determine long term outcomes, regarding recurrence and survival, in patients with HCC that achieved complete response after initial treatment with drug eluting beads (DEB) using DC Bead loaded with doxorubicin (DEB-DOX).
Methodology:
Forty-five patients with HCC, not suitable for curative treatments that exhibited complete response (EASL criteria) to initial DEB-DOX treatment were retrospectively analyzed after a median follow up period of 63 months. Child-Pugh class was A/B (62.2/37.8%) and mean lesion diameter 5.36 ± 1.1 cm. Lesion morphology was one dominant ≤5cm (53.3%), one dominant >5cm (31.1%) and multifocal (15.6%).
Results:
At 5 years, overall survival was 62.2% and recurrence-free survival 8.9%. All deaths that occurred were related to tumor progression (31.1%) or complications of underlying liver disease (28.9%). Median time of initial recurrence from baseline treatment was 18 months (range 8-52). When recurrence occurred, a mean time interval between additional DEB-DOX procedures less than 9 months was correlated to a poorer prognosis (p=0.025). Multivariate analysis identified Child-Pugh class at baseline (p=0.048), combined therapy of recurrences with local ablation (p=0.03) and number of DEB-DOX procedures (p=0.037) as significant prognostic factors of 5-year survival. Lesion morphology displayed significance for recurrence-free survival (p=0.014). Child-Pugh class at baseline, additional local ablation, pattern of initial recurrence and initial sum of recurrent tumor diameters all displayed statistical significance for post-recurrence survival (median 40 months), with the first two variables maintaining statistical significance in multivariate analysis (p=0.015 and p=0.014 respectively).
Conclusion:
Initial complete response to DEB-DOX ensures a favorable prognosis. However, management of recurrent tumors, which occur frequently mostly as new lesions, and preservation of underlying liver function appear to play a key role in prolonging survival.
