A5: Progression of Hepatocellular Carcinoma After Complete Radiologic Response to Transarterial Embolization

Saturday, March 12, 2022

11:11 AM – 11:19 AM CST

Location: Chantilly West

Abstract Presenter(s)

CRISANTA ILAGAN, MD

Postdoctoral Research Fellow
Memorial Sloan Kettering Cancer Center
Brooklyn, New York, United States

Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Participants should be aware of the following financial/non-financial relationships:

CRISANTA ILAGAN, MD: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Introduction:

Little is known about the natural history of patients with unresectable, liver-confined hepatocellular carcinoma (HCC) who had complete radiologic response (CR) to transarterial embolization and do not undergo subsequent resection or transplantation.

Methods: A retrospective review of patients who participated in a randomized phase II trial comparing bland hepatic artery embolization (HAE) or transarterial chemoembolization (TACE) with doxorubicin-loaded microspheres and had CR by modified RECIST criteria was performed. The overall survival (OS), incidence and patterns of progression, and factors associated with progression were assessed.

Results: Of the 101 patients in the trial, 37 with CR were included. In this cohort, 17 patients were treated with HAE (46%) and 20 with TACE (54%). The median age was 67 years (range: 42-82). Majority were male (86.5%) and Caucasian (78%). The median pre-treatment MELD score was 10, 70% had BCLC Stage B or C and 38% had extrahepatic disease. Median follow up was 49 months (95%CI: 9-108) with a median OS of 25 months (95%CI: 18.9-30.9). Three-year and 5-year survival were 31% (95%CI: 16.7-45.9%) and 18% (95%CI: 6.8-32.1%). Six-month, 1-year, and 2-year cumulative incidence of progression were 51% (95%CI: 34.0-66.2%), 76% (95%CI: 57.7-86.8%), and 92% (95%CI: 74.5-97.6%), respectively. The most common site of first recurrence was local (previously treated tumor; 32%, 12/37) followed by regional (hepatic tumor separate from treated tumor; 24%, 9/37). One-year and 2-year incidence of progression was 38% (95%CI: 22.3-53.3%) and 60% (95%CI: 41.4-73.6%) for local; 51% (95%CI: 34.0-66.2%) and 70% (95%CI: 52-82.7%) for regional; and 27% (95%CI: 13.9-42.0%) and 43% (95%CI: 26.8-58.6%) for distant (extra-hepatic tumor; Figure 1). Patients with higher AFP values had a higher hazard of death (HR: 1.36, 95%CI: 1.16-1.59, p< 0.001) and a higher hazard of any progression (HR: 1.20, 95%CI: 1.04-1.38, p=0.012).

Conclusions:

Patients with advanced-stage HCC and CR to embolization do not have durable response and have inevitable disease progression. Most patients with progression have liver-confined disease and should be evaluated for additional consolidative treatments.

Learning Objectives:

Describe the natural history of patients with unresectable, liver-confined hepatocellular carcinoma who had complete radiologic response to transarterial embolization and do not undergo subsequent resection or transplantation.
List the patterns of HCC recurrence in patients with unresectable, liver-confined hepatocellular carcinoma who had complete radiologic response to transarterial embolization and do not undergo subsequent resection or transplantation.
Define the overall survival of unresectable, liver-confined hepatocellular carcinoma who had complete radiologic response to transarterial embolization and do not undergo subsequent resection or transplantation.