Local Recurrence following Radiological Complete Response in Patients Treated with Subsegmental Balloon-Occluded Transcatheter Arterial Chemoembolization for Hepatocellular Carcinoma

SIMPLE SUMMARY: Balloon-occluded transcatheter arterial chemoembolization (B-TACE), in which a microballoon catheter is used to temporarily occlude the tumor feeding artery, was introduced to increase complete response (CR) rates. However, assessing the quality of CR in terms of the therapeutic outcomes of B-TACE is necessary because the evaluation of local recurrence (LR) may provide more detailed information on the ability of the B-TACE to result in a local cure. This study aimed to determine the LR rate and identify factors associated with LR in patients who achieve a radiological CR after undergoing subsegmental B-TACE for HCC. The CR rate after B-TACE was 97.2% at first follow-up. Oily subsegmentectomy, defined as radiological CR of the HCC and peritumoral parenchymal necrosis, can be considered as an index of successful treatment because it did not demonstrate any LR. ABSTRACT: The aim of this study was to determine the local recurrence (LR) rate and identify factors associated with LR in patients who achieve a radiological complete response (CR) after undergoing balloon-occluded transcatheter arterial chemoembolization (B-TACE) for hepatocellular carcinoma (HCC). From November 2017 to September 2021, 60 patients (44 men, 16 women; mean age, 63.5 years; range, 39–82 years) with 72 HCCs (mean diameter, 31 mm; range, 10–50 mm) who underwent subsegmental B-TACE were included in this retrospective study. Radiological and clinical evaluation of oily subsegmentectomy, defined as radiological CR of the HCC and peritumoral parenchymal necrosis, was performed. The CR rate was 97.2% (70 of 72 HCCs) at first follow-up (mean, 41 days; range, 14–110 days). Overall, 13 HCCs (19.7%) demonstrated LR at a mean of 29.8 months (range, 3–63 months) and cumulative LR rates were 1.5% 14.2% 21%, 21%, and 21% at 6, 12, 24, 36, and 48 months, respectively. In 28 (38.9%) of 72 HCCs, oily subsegmentectomy was achieved, tumor markers were normalized, and LR did not occur. The oily subsegmentectomy-positive group had a significantly lower LR rate than the oily subsegmentectomy-negative group (p = 0.001). Age ≥65 years (adjusted hazard ration (HR), 0.124; 95% confidence interval (CI), 0.037–0.412; p < 0.001) and peripheral location (adjusted HR, 0.112; 95% CI, 0.046–0.272; p < 0.001) were independent predictive factors of LR. Subsegmental B-TACE can be an effective method with a high initial CR rate and low LR incidence. Oily subsegmentectomy can be considered as an index of successful treatment because it did not demonstrate any LR.