ABSTRACT
PURPOSE: To define the number of TACE sessions needed to improve patients' overall survival (OS) in different subgroups of unresectable HCC. METHODS: This retrospective cohort included 180 patients who got TACE between 2005-2016 as the initial treatment for unresectable HCC. Tumor margin (well- vs. ill-defined) was determined by two radiologists at baseline. Well-defined group was divided into two groups (ADC-responders vs. ADC-nonresponders) based on %ADC change (ΔADC-cutoffâ¯=â¯25 %). Accordingly, patients were categorized into three groups, ill-defined, well-defined ADC-responders, or well-defined ADC-nonresponders. Cox-analysis was used to compare the survival benefit of multiple TACE in different groups. RESULTS: Ill-defined HCC (nâ¯=â¯108) was associated with worse survival (HRâ¯=â¯1.95,pâ¯<â¯0.001). Multiple TACE were associated with increased OS (HRâ¯=â¯0.88,pâ¯=â¯0.033) in these patients, with significant survival improvement after ≥4TACE. ΔADC was not related to OS in ill-defined group. In well-defined group (nâ¯=â¯72), multiple TACE were not associated with improved OS (HRâ¯=â¯0.181,pâ¯=â¯0.090). These patients were categorized into two groups based on ΔADC-cutoff. ADC-responders (ΔADC≥25 %) had the longest survival than other groups(pâ¯=â¯0.015). Multiple TACE sessions were not associated with better OS in this group (HRâ¯=â¯1.004,pâ¯=â¯0.982). By contrast, incremental number of TACE were associated with significantly longer OS in ADC-nonresponders (ΔADC<25 %) (HRâ¯=â¯0.79,pâ¯=â¯0.034). These patients' OS significantly improved after ≥3TACE. CONCLUSION: The survival benefit of sequential TACE sessions varies for different HCC subgroups. There was no significant survival benefit associated with multiple TACE in well-defined lesions responding to the first TACE. The most survival benefit was for ADC-nonresponder well-defined group and it was least for ill-defined HCC group, regardless of ADC-response.
