Watershed Hepatocellular Carcinomas: The Risk of Incomplete Response following Transhepatic Arterial Chemoembolization
| Autor: | John D. Louie, Ali M. Tahvildari, Kerstin Mueller, Patrick G. Sullivan, Daniel Y. Sze, Chris Takehana, Vishal Sidhar, Jarrett Rosenberg, Nishita Kothary |
|---|---|
| Rok vydání: | 2015 |
| Předmět: |
Adult
Male medicine.medical_specialty Carcinoma Hepatocellular Milan criteria Gastroenterology California Disease-Free Survival Liver disease Age Distribution Model for End-Stage Liver Disease Risk Factors Internal medicine medicine Humans Neoplasm Invasiveness Radiology Nuclear Medicine and imaging Chemoembolization Therapeutic Sex Distribution Survival rate Aged Retrospective Studies business.industry Incidence Liver Neoplasms Middle Aged medicine.disease Survival Rate Transplantation Treatment Outcome Response Evaluation Criteria in Solid Tumors Hepatocellular carcinoma Female Neoplasm Recurrence Local Cardiology and Cardiovascular Medicine business Nuclear medicine Progressive disease |
| Zdroj: | Journal of Vascular and Interventional Radiology. 26:1122-1129 |
| ISSN: | 1051-0443 |
| DOI: | 10.1016/j.jvir.2015.04.030 |
| Popis: | Purpose Hepatocellular carcinomas (HCCs) bridging two or more Couinaud–Bismuth segments of the liver ("watershed tumors") can recruit multiple segmental arteries. The primary hypothesis of this study was that fewer watershed tumors show complete response (CR) after chemoembolization, with shorter time to local recurrence. Secondary analysis on the impact on transplantation eligibility in the presence of progressive disease was also performed. Materials and Methods A total of 155 transplantation-eligible patients whose HCC met Milan criteria (watershed, n=83; nonwatershed, n=72) and was treated with chemoembolization were included. Cone-beam computed tomography (CT) was used for guidance and for confirmation of circumferential uptake. Local response to chemoembolization per modified Response Evaluation Criteria In Solid Tumors and local disease-free survival (DFS) for the index tumor were calculated. Differences were assessed by univariate and multivariate analyses. Results CR after a single of chemoembolization was observed in 55.4% of watershed tumors and in 72.2% of nonwatershed tumors ( P = .045). Estimated DFS intervals were 151 days (95% confidence interval [CI], 93–245 d) and 336 days (95% CI, 231–747 d; P = .040) in the watershed and nonwatershed groups, respectively. Worse DFS was observed with a Model for End-Stage Liver Disease score > 20 ( P = .0001), higher Child–Pugh–Turcotte score ( P = .049), and watershed location ( P = .040). Waiting list drop-off rates were statistically similar between groups. Conclusions Hepatocellular carcinomas located in the watershed region of the liver have a poorer response to chemoembolization than those located elsewhere. These tumors are associated with worse DFS and require additional treatments to maintain transplantation eligibility per Milan criteria. Cone-beam CT can identify crossover supply and confirm complete geographic drug uptake, possibly reducing (but not eliminating) the risk of incomplete response. |
| Databáze: | OpenAIRE |
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