Impact of the Interval between Transarterial Chemoembolization Sessions on Survival in Patients with Unresectable Hepatocellular Carcinoma

To evaluate clinical impact of different intervals between multiple transarterial chemoembolization sessions in patients with unresectable hepatocellular carcinoma (HCC).

A retrospective cohort study of 305 consecutive patients with HCC who underwent multiple sessions of on-demand transarterial chemoembolization by two independent physicians with different management policies in terms of transarterial chemoembolization interval was performed; 180 patients had intervals between the first and second transarterial chemoembolization session of < 60 days (short-interval group), and 125 patients had transarterial chemoembolization intervals of ≥ 60 days (conventional-interval group).

The short-interval group had more cases of advanced-stage HCC, less favorable response to transarterial chemoembolization, and higher likelihood of having Child-Pugh class A. The short-interval group underwent more transarterial chemoembolization sessions (6.6 vs 5.5, P = .011), although the total number of admissions and total hospital stay were similar to the conventional-interval group. Overall survival was similar in the two groups in the full and the propensity score-matched cohorts. Although the overall survival of patients with Child-Pugh class A was comparable between the two groups in the full and propensity score-matched cohorts, the short-interval group showed inferior survival (P = .005) and a nonsignificant trend toward inferior survival (P = .117) in the full and propensity score-matched cohorts, respectively, for patients with Child-Pugh class B.

Transarterial chemoembolization interval did not affect survival outcomes of patients with Child-Pugh class A. A shorter transarterial chemoembolization interval showed a nonsignificant trend of adversely affecting survival for patients with Child-Pugh class B.