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Reason of Discontinuation After Transarterial Chemoembolization Influences Survival in Patients with Hepatocellular Carcinoma
BACKGROUND: Transarterial chemoembolization (TACE) for intermediate-stage hepatocellular carcinoma (HCC) is often repeated until unTACEable progression (UTP) occurs. There is little data on the various reasons for stopping TACE and its consequences for subsequent treatment and survival. AIM: To asse...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer US
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6344387/ https://www.ncbi.nlm.nih.gov/pubmed/30488302 http://dx.doi.org/10.1007/s00270-018-2118-6 |
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author | Labeur, Tim A. Takkenberg, R. Bart Klümpen, Heinz-Josef van Delden, Otto M. |
author_facet | Labeur, Tim A. Takkenberg, R. Bart Klümpen, Heinz-Josef van Delden, Otto M. |
author_sort | Labeur, Tim A. |
collection | PubMed |
description | BACKGROUND: Transarterial chemoembolization (TACE) for intermediate-stage hepatocellular carcinoma (HCC) is often repeated until unTACEable progression (UTP) occurs. There is little data on the various reasons for stopping TACE and its consequences for subsequent treatment and survival. AIM: To assess the impact of the various reasons of UTP on survival and consequences for subsequent treatments. METHODS: Consecutive HCC patients who underwent TACE between 2003 and 2016 were analyzed retrospectively for the reason of TACE discontinuation. UTP was defined according to the EASL guidelines, considering radiological pattern of progression, liver function and performance status (PS). Overall and post-progression survival (OS, PPS) for different reasons of TACE discontinuation were compared. The correlation between time to untreatable progression by chemoembolization (TTUPc) and OS was analyzed. RESULTS: One hundred and sixty-six patients (BCLC-A 40%, BCLC-B 54%, BCLC-C: 7%) were included, undergoing a median of 2 TACE procedures with a median OS of 22.1 months (95% CI 17.4–26.7). UTP occurred in 116 patients (70%) after a median TTUPc of 11.6 months (95% CI 7.8–15.4). There was a strong positive correlation (ρ = 0.816, p < 0.001) between TTUPc and OS. The main reason of UTP was radiological progression (61%), which was mostly intrahepatic (75%). Hepatic decompensation and worsening of PS were independent predictors of OS and PPS. CONCLUSION: The majority of HCC patients treated with TACE have UTP due to intrahepatic tumor progression with preserved liver function and PS, making them potential candidates for subsequent liver-directed or systemic treatment. TTUPc may be a valuable surrogate endpoint for OS in patients treated with TACE. LEVEL OF EVIDENCE: Level II, prognosis study. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s00270-018-2118-6) contains supplementary material, which is available to authorized users. |
format | Online Article Text |
id | pubmed-6344387 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | Springer US |
record_format | MEDLINE/PubMed |
spelling | pubmed-63443872019-02-08 Reason of Discontinuation After Transarterial Chemoembolization Influences Survival in Patients with Hepatocellular Carcinoma Labeur, Tim A. Takkenberg, R. Bart Klümpen, Heinz-Josef van Delden, Otto M. Cardiovasc Intervent Radiol Clinical Investigation BACKGROUND: Transarterial chemoembolization (TACE) for intermediate-stage hepatocellular carcinoma (HCC) is often repeated until unTACEable progression (UTP) occurs. There is little data on the various reasons for stopping TACE and its consequences for subsequent treatment and survival. AIM: To assess the impact of the various reasons of UTP on survival and consequences for subsequent treatments. METHODS: Consecutive HCC patients who underwent TACE between 2003 and 2016 were analyzed retrospectively for the reason of TACE discontinuation. UTP was defined according to the EASL guidelines, considering radiological pattern of progression, liver function and performance status (PS). Overall and post-progression survival (OS, PPS) for different reasons of TACE discontinuation were compared. The correlation between time to untreatable progression by chemoembolization (TTUPc) and OS was analyzed. RESULTS: One hundred and sixty-six patients (BCLC-A 40%, BCLC-B 54%, BCLC-C: 7%) were included, undergoing a median of 2 TACE procedures with a median OS of 22.1 months (95% CI 17.4–26.7). UTP occurred in 116 patients (70%) after a median TTUPc of 11.6 months (95% CI 7.8–15.4). There was a strong positive correlation (ρ = 0.816, p < 0.001) between TTUPc and OS. The main reason of UTP was radiological progression (61%), which was mostly intrahepatic (75%). Hepatic decompensation and worsening of PS were independent predictors of OS and PPS. CONCLUSION: The majority of HCC patients treated with TACE have UTP due to intrahepatic tumor progression with preserved liver function and PS, making them potential candidates for subsequent liver-directed or systemic treatment. TTUPc may be a valuable surrogate endpoint for OS in patients treated with TACE. LEVEL OF EVIDENCE: Level II, prognosis study. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s00270-018-2118-6) contains supplementary material, which is available to authorized users. Springer US 2018-11-28 2019 /pmc/articles/PMC6344387/ /pubmed/30488302 http://dx.doi.org/10.1007/s00270-018-2118-6 Text en © The Author(s) 2018 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. |
spellingShingle | Clinical Investigation Labeur, Tim A. Takkenberg, R. Bart Klümpen, Heinz-Josef van Delden, Otto M. Reason of Discontinuation After Transarterial Chemoembolization Influences Survival in Patients with Hepatocellular Carcinoma |
title | Reason of Discontinuation After Transarterial Chemoembolization Influences Survival in Patients with Hepatocellular Carcinoma |
title_full | Reason of Discontinuation After Transarterial Chemoembolization Influences Survival in Patients with Hepatocellular Carcinoma |
title_fullStr | Reason of Discontinuation After Transarterial Chemoembolization Influences Survival in Patients with Hepatocellular Carcinoma |
title_full_unstemmed | Reason of Discontinuation After Transarterial Chemoembolization Influences Survival in Patients with Hepatocellular Carcinoma |
title_short | Reason of Discontinuation After Transarterial Chemoembolization Influences Survival in Patients with Hepatocellular Carcinoma |
title_sort | reason of discontinuation after transarterial chemoembolization influences survival in patients with hepatocellular carcinoma |
topic | Clinical Investigation |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6344387/ https://www.ncbi.nlm.nih.gov/pubmed/30488302 http://dx.doi.org/10.1007/s00270-018-2118-6 |
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