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European Radiology
Published in: European Radiology 6/2021

01-06-2021 | Hepatocellular Carcinoma | Interventional

A prediction model for overall survival after transarterial chemoembolization for hepatocellular carcinoma invading the hepatic vein or inferior vena cava

Authors: Hee Ho Chu, Seng-Yong Chun, Jin Hyoung Kim, Pyeong Hwa Kim, Dong Il Gwon, Heung-Kyu Ko, Nayoung Kim

Published in: European Radiology | Issue 6/2021

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Abstract

Objectives

An effective therapeutic option has not yet been established for hepatocellular carcinoma (HCC) invading the hepatic vein (HV) or inferior vena cava (IVC). This study aimed to determine the therapeutic effect of transarterial chemoembolization (TACE) in HCC patients with HV or IVC invasion, and to build a risk prediction model.

Methods

Data from patients who underwent TACE as a first-line treatment for HCC invading the HV or IVC between 1997 and 2019 were retrospectively evaluated.

Results

Data from 296 patients were included (1997–2006 comprised the training cohort, n = 174; 2007–2019 comprised the validation cohort, n = 122). The median post-TACE survival was 7.3 months and an objective tumor response was achieved in 34.1% of patients. Multivariable Cox analysis of the training cohort identified five pretreatment factors (maximal tumor size > 10 cm, infiltrative HCC, combined portal vein invasion, extrahepatic metastasis, and ECOG performance status 1), which were used to create predictive models for overall survival. Median overall survival times in the validation cohort were 14 and 4.2 months for the low (sum of risk score: 0–3)- and high-risk (sum of risk score: 4–7) groups, respectively (p < 0.001). Time-dependent ROC curves for the predictive models for overall survival applied to the validation cohort showed acceptable AUC values (0.723 and 0.667 at 6 months and 1 year).

Conclusions

TACE seems effective for selected patients with HCC invading the HV or IVC. The predictive model may help to identify candidates most likely to benefit from TACE.

Key Points

• To develop a risk prediction model for patients with HCC with HV or IVC invasion treated with TACE, five factors were selected from a multivariate Cox regression model for overall survival.
• The combination of these factors helped to identify two prognostic categories: low- and high-risk.
• The predictive model can help to select candidates who will benefit most from TACE in this patient group.
Literature
1.
Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A (2018) Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 68:394–424
2.
European Association for The Study of The Liver; European Organisation for Research and Treatment of Cancer (2012) EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma. J Hepatol 56:908–943CrossRef
3.
Pawlik TM, Poon RT, Abdalla EK et al (2005) Hepatectomy for hepatocellular carcinoma with major portal or hepatic vein invasion: results of a multicenter study. Surgery 137:403–410CrossRef
4.
Kim JH, Shim JH, Yoon HK, Ko HK, Kim JW, Gwon DI (2018) Chemoembolization related to good survival for selected patients with hepatocellular carcinoma invading segmental portal vein. Liver Int 38:1646–1654
5.
Forner A, Reig M, Bruix J (2018) Hepatocellular carcinoma. Lancet 391:1301–1314CrossRef
6.
Llovet JM, Bustamante J, Castells A et al (1999) Natural history of untreated nonsurgical hepatocellular carcinoma: rationale for the design and evaluation of therapeutic trials. Hepatology 29:62–67CrossRef
7.
Schöniger-Hekele M, Müller C, Kutilek M, Oesterreicher C, Ferenci P, Gangl A (2001) Hepatocellular carcinoma in Central Europe: prognostic features and survival. Gut 48:103–109CrossRef
8.
Cabibbo G, Enea M, Attanasio M, Bruix J, Craxì A, Cammà C (2010) A meta-analysis of survival rates of untreated patients in randomized clinical trials of hepatocellular carcinoma. Hepatology 51:1274–1283CrossRef
9.
Marrero JA, Kulik LM, Sirlin CB et al (2018) Diagnosis, staging, and management of hepatocellular carcinoma: 2018 Practice Guidance by the American Association for the Study of Liver Diseases. Hepatology 68:723–750CrossRef
10.
Llovet JM, Ricc S, Mazzaferro V et al (2008) Sorafenib in advanced hepatocellular carcinoma. N Engl J Med 359:378–390CrossRef
11.
Cheng AL, Kang YK, Chen Z et al (2009) Efficacy and safety of sorafenib in patients in the Asia-Pacific region with advanced hepatocellular carcinoma: a phase III randomized, double-blind, placebo-controlled trial. Lancet Oncol 10:25–34CrossRef
12.
Vilgrain V, Pereira H, Assenat E et al (2017) SARAH Trial Group. Efficacy and safety of selective internal radiotherapy with yttrium-90 resin microspheres compared with sorafenib in locally advanced and inoperable hepatocellular carcinoma (SARAH): an open-label randomised controlled phase 3 trial. Lancet Oncol 18:1624–1636CrossRef
13.
Kim PH, Choi SH, Kim JH, Park SH (2019) Comparison of Radioembolization and sorafenib for the treatment of hepatocellular carcinoma with portal vein tumor thrombosis: a systematic review and meta-analysis of safety and efficacy. Korean J Radiol 20:385–398CrossRef
14.
Liver Cancer Study Group of Japan (1990) Primary liver cancer in Japan: clinicopathologic features and results of surgical treatment. Ann Surg 211:277–287
15.
Tsuzuki T, Ogata Y, Iida S, Shimazu M (1984) Hepatic resection in 125 patients. Arch Surg 119:1025–1032CrossRef
16.
Chung SM, Yoon CJ, Lee SS et al (2014) Treatment outcomes of transcatheter arterial chemoembolization for hepatocellular carcinoma that invades hepatic vein or inferior vena cava. Cardiovasc Intervent Radiol 37:1507–1515CrossRef
17.
Kim HC, Lee JH, Chung JW et al (2013) Transarterial chemoembolization with additional cisplatin infusion for hepatocellular carcinoma invading the hepatic vein. J Vasc Interv Radiol 24:274–283CrossRef
18.
Koo JE, Kim JH, Lim YS et al (2010) Combination of transarterial chemoembolization and three-dimensional conformal radiotherapy for hepatocellular carcinoma with inferior vena cava tumor thrombus. Int J Radiat Oncol Biol Phys 78:180–187CrossRef
19.
Kokudo T, Hasegawa K, Matsuyama Y et al (2017) Liver resection for hepatocellular carcinoma associated with hepatic vein invasion: a Japanese nationwide survey. Hepatology 66:510–517CrossRef
20.
European Association For The Study Of The Liver (2018) EASL Clinical Practice Guidelines: management of hepatocellular carcinoma. J Hepatol 69:182–236CrossRef
21.
Hu HT, Kim JH, Lee LS et al (2011) Chemoembolization for hepatocellular carcinoma: multivariate analysis of predicting factors for tumor response and survival in a 362-patient cohort. J Vasc Interv Radiol 22:917–923CrossRef
22.
Bruix J, Sherman M, Llovet JM et al (2001) Clinical management of hepatocellular carcinoma. Conclusions of the Barcelona-2000 EASL conference. European Association for the Study of the Liver. J Hepatol 35:421–430CrossRef
23.
Khalizadeh O, Baerlocher MO, Shyn PB et al (2017) Proposal of a new adverse event classifications by the Society of Interventional Radiology Standards of Practice Committee. J Vasc Interv Radiol 28:1432–1437CrossRef
24.
Sullivan LM, Massaro JM, D’Agostino RB Sr (2004) Presentation of multivariate data for clinical use: the framingham study risk score functions. Stat Med 23:1631–1660CrossRef
25.
Uno H, Cai T, Tian L, Wei LJ (2007) Evaluating prediction rules for t-year survivors with censored regression models. J Am Stat Assoc 102:527–537CrossRef
26.
Nagasue N, Yukaya H, Hamada, Hirose S, Kanashima R, Inokuchi KT et al (1984) The natural history of hepatocellular carcinoma. A study of 100 untreated cases. Cancer 54:1461–1465
27.
Zeng ZC, Fan J, Tang ZY et al (2005) A comparison of treatment combinations with and without radiotherapy for hepatocellular carcinoma with portal vein and/or inferior vena cava tumor thrombus. Int J Radiat Oncol Biol Phys 61:432–443CrossRef
28.
Nakazawa T, Adachi S, Kitano M et al (2007) Potential prognostic benefits of radiotherapy as an initial treatment for patients with unresectable advanced hepatocellular carcinoma with invasion to intrahepatic large vessels. Oncology 73:90–97CrossRef
29.
Lu J, Zhang XP, Zhong BY et al (2019) Management of patients with hepatocellular carcinoma and portal vein tumour thrombosis: comparing east and west. Lancet Gastroenterol Hepatol 4:721–730CrossRef
30.
Spreafico C, Sposito C, Vaiani M et al (2018) Development of a prognostic score to predict response to Yttrium-90 radioembolization for hepatocellular carcinoma with portal vein invasion. J Hepatol 68:724–732CrossRef
31.
Chern MC, Chuang VP, Cheng T, Lin ZH, Lin YM (2008) Transcatheter arterial chemoembolization for advanced hepatocellular carcinoma with inferior vena cava and right atrial tumors. Cardiovasc Intervent Radiol 31:735–744CrossRef
32.
Lee IC, Hung YW, Liu CA et al (2019) A new ALBI-based model to predict survival after transarterial chemoembolization for BCLC stage B hepatocellular carcinoma. Liver Int 39:1704–1712CrossRef
33.
Yoon SM, Ryoo BY, Lee SJ et al (2018) Efficacy and safety of transarterial chemoembolization plus external beam radiotherapy vs sorafenib in hepatocellular carcinoma with macroscopic vascular invasion: a randomized clinical trial. JAMA Oncol 4:661–669CrossRef
34.
Kudo M, Ueshima K, Ikeda M et al (2020) Randomised, multicentre prospective trial of transarterial chemoembolization (TACE) plus sorafenib as compared with TACE alone in patients with hepatocellular carcinoma: TACTICS trial. Gut 69:1492–1501CrossRef
35.
Kudo M (2019) Scientific rationale for combination immunotherapy of hepatocellular carcinoma with anti-PD-1/PD-L1 and anti-CTLA-4 antibodies. Liver Cancer 8:413–426CrossRef
36.
Chu HH, Kim JH, Shim JH, Yoon SM, Kim PH, Alrashidi I (2020) chemoembolization plus radiotherapy versus chemoembolization plus sorafenib for the treatment of hepatocellular carcinoma invading the portal vein: a propensity score matching analysis. Cancers 12:1116
37.
Cheng AL, Qin S, Ikeda M et al (2019) IMbrave 150: efficacy and safety results from a ph III study evaluating atezolizumab (atezo) + bevacizumab (bev) vs sorafenib (Sor) as first treatment (tx) for patients (pts) with unresectable hepatocellular carcinoma (HCC). Ann Oncol 30(9 suppl):ix186–ix187CrossRef
38.
Stein S, Pishvaian MJ, Lee MS et al (2018) Safety and clinical activity of 1L atezolizumab + bevacizumab in a phase Ib study in hepatocellular carcinoma (HCC). J Clin Oncol 36(15_suppl):4074CrossRef
39.
Ikeda M, Sung MW, Kudo M et al (2018) A Phase 1B trial of lenvatinib (LEN) plus pembrolizumab (PEM) in patients (PTS) with unresectable hepatocellular carcinoma (uHCC). J Clin Oncol 36(15_suppl):4076CrossRef
40.
Duffy AG, Ulahannan SV, Makorova-Rusher O et al (2017) Tremelimumab in combination with ablation in patients with advanced hepatocellular carcinoma. J Hepatol 66:545–551CrossRef
41.
Zhan C, Ruohoniemi D, Shanbhogue KP et al (2020) Safety of combined yttrium-90 radioembolization and immune checkpoint inhibitor immunotherapy for hepatocellular carcinoma. J Vasc Interv Radiol 31:25–34CrossRef
42.
An C, Kim DW, Park YN, Chung YE, Rhee H, Kim MJ (2015) Single hepatocellular carcinoma: preoperative MR imaging to predict early recurrence after curative resection. Radiology 276:433–443CrossRef
43.
Bargellini I, Bozzi E, Campani D et al (2013) Modified RECIST to assess tumor response after transarterial chemoembolization of hepatocellular carcinoma: CT-pathologic correlation in 178 liver explants. Eur J Radiol 82:e212–e218CrossRef
44.
Dioguardi Burgio M, Ronot M, Bruno O et al (2016) Correlation of tumor response on computed tomography with pathological necrosis in hepatocellular carcinoma treated by chemoembolization before liver transplantation. Liver Transpl 22:1491–1500CrossRef
Metadata
Title
A prediction model for overall survival after transarterial chemoembolization for hepatocellular carcinoma invading the hepatic vein or inferior vena cava
Authors
Hee Ho Chu
Seng-Yong Chun
Jin Hyoung Kim
Pyeong Hwa Kim
Dong Il Gwon
Heung-Kyu Ko
Nayoung Kim
Publication date
01-06-2021
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 6/2021
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-020-07536-8

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