Survival benefit of sequential curative treatment for TACE suitable BCLC stage B HCC patients

Area of Science:

• Hepatobiliary Medicine
• Interventional Radiology
• Oncology

Background:

• Hepatocellular carcinoma (HCC) is a major global health concern.
• Barcelona Clinic Liver Cancer (BCLC) stage B HCC often requires multimodal treatment.
• Transcatheter arterial chemoembolization (TACE) is a common initial therapy for BCLC B HCC.

Purpose of the Study:

• To evaluate the survival benefit of sequential curative treatments following transcatheter arterial chemoembolization (TACE) in BCLC stage B HCC.
• To identify predictors of treatment response and survival after initial TACE.
• To compare the efficacy of different post-TACE treatment strategies.

Main Methods:

• Retrospective analysis of 77 treatment-naïve BCLC B HCC patients treated between July 2017 and July 2020.
• Initial treatment primarily involved TACE.
• Treatment response was assessed using CT/MRI after 2-3 TACE cycles and categorized into complete response, incomplete without new growth, incomplete with new growth, and progression.

Main Results:

• Median survival for the TACE-only group was 30 months.
• Among patients with incomplete response without new tumor growth, those receiving radiofrequency ablation (RFA) (Gr2a) had significantly longer median survival (>60 months) than those receiving repeat TACE (Gr2b) (20 months).
• Complete response rates were higher in the RFA group (69%) compared to the repeat TACE group (0%).

Conclusions:

• In TACE-suitable BCLC stage B HCC patients, achieving a partial response without new tumor growth after initial TACE is a positive prognostic indicator.
• Sequential treatment with RFA for selected patients demonstrating partial response post-TACE can lead to improved survival outcomes compared to repeat TACE.
• This study highlights the importance of response assessment for guiding subsequent treatment decisions in BCLC B HCC management.