Radiologic Morphologies Predict Tumor Response and Patient Survival Following Chemoembolization for Single Large (>5...

To evaluate the role of radiologic morphologies on oncologic outcomes following transarterial chemoembolization (TACE) in patients with inoperable, single large (>5 to ≤10 cm) hepatocellular carcinoma (HCC).

Data from 391 treatment-naïve patients with preserved liver function who received TACE as the first-line treatment for single large (>5 to ≤10 cm) HCC without macrovascular invasion and extrahepatic metastasis between 2007 and 2023 were retrospectively analyzed. Radiologic tumor morphology was classified according to the definition of the Liver Cancer Study Group of Japan: encapsulated nodular, simple nodular type with extranodular growth, confluent multinodular, and infiltrative. Adverse events, radiologic tumor response, progression-free survival (PFS), and overall survival (OS) after TACE were analyzed in relation to tumor morphology.

Following TACE, complete response rates were 91%, 86%, 71%, and 36% for encapsulated, extranodular, confluent, and infiltrative types, respectively (P < .001). Major adverse event rates were 7%, 12%, 10%, and 14% (P = .5). The median PFS and OS were 42 and 81 months in patients with encapsulated nodular, 22 and 75 months in those with extranodular growth, 19 and 43 months in those with confluent multinodular, and 5 and 26 months in those with infiltrative types, respectively (P < .001).

Radiologic morphologic classification is a significant predictor of tumor response and survival outcomes in patients with single large HCC (>5 to ≤10 cm) undergoing TACE, with outcomes progressively worsening from encapsulated nodular through extranodular growth and confluent multinodular to infiltrative types.