Bony George*, Krishnadas Devadas, Sandesh K, Jineesh V, Tharun Tom Oomen, Jijo Varghese, Arun P, Eldhose Elias George, Vijay Narayanan
Background and aims: Transarterial chemoembolization (TACE) can improve the overall survival of patients with intermediate-stage HCC. A modified response evaluation criterion in solid tumours (mRECIST) is used for evaluation of the treatment response in patients after TACE. We tried to evaluate the response and survival in patients after TACE.
Methods: Patients underwent superselective TACE with Epirubicin. The mRECIST response was calculated after 6 weeks using MRI. Predictive factors were calculated for response and survival
Results: 42 patients with intermediate HCC were analysed. The mean age was 59.12 ± 8.74 years. The predominant etiology was NASH in 31% and alcohol in 23.8%. 23 patients had complete response (CR), 8 patients had partial response (PR), 4 patients had stable disease (SD) and 7 patients had progressive disease (PD), as per mRECIST criteria. Objective response (or) was defined as patients having either CR or PR and poor response (PoR) as patients having either SD or PD. 73.8% had an objective response and 26.2% had a poor response. HAP score (p=0.003) and CHILD stage (p=0.011) were the most important predictive variables for the mRECIST response. Mortality was highest among the patients with poor response, 8/11(72.7%). 10/31(32.2%) patients with objective response died during the follow up period. Mean survival was significantly higher in patients with OR (25.64 months) than in patients with PoR (13.1 months), p=0.001. mRECIST response predicted survival among the patients on univariate analysis (HR=1.08, p=0.02). The independent predictors for survival were post-TACE decompensation (B-1.43, p=0.03), ECOG performance status (B-1.41, p=0.010), and the number of lesions (HR 2.20, p=0.017).
Conclusion: Use of TACE in intermediate stage HCC patients gives a significant survival advantage when objective response is achieved as per mRECIST. Proper selection of the patients for TACE is important for objective response and survival
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