Assessing the prognostic significance of tumor growth rate in patients with huge hepatocellular carcinoma undergoing transcatheter arterial chemoembolization

Abstract

Abstract: Objective To investigate the prognostic implications of tumor growth rate in patients presenting with huge hepatocellular carcinoma (HCC) initially treated with transcatheter arterial chemoembolization (TACE). Methods The clinical records of patients with huge HCC who underwent TACE treatment at our institution between January 2016 and March 2020 were retrospectively examined. This study involved the collection of demographic, oncological, and serological parameters. The X-tile software was utilized to determine the optimal tumor growth rate threshold for stratifying overal survival(OS) among the cohort. Survival discrepancies based on varing tumor growth rates within 3 years post-TACE were assessed using the Kaplan-Meier method, with intergroup differences evaluated via the Log-rank test. Additionally, A Cox proportional hazards regression model was employed to elucidate factors influencing patient OS. Results The dtermined optimal cutoff value for prognosticating the 3-year survival of patients based on with tumor growth rate was -11.7% per month. Ptiantes were stratified into a low tumor growth rate group(n=52) and a high tumor growth rate group (n=46) according to this threshold,. Kaplan-Meier analysis revealed superior OS in the low tumor growth rate group compared to the high tumor growth rate group(χ²=7.120,P=0.008). The multivariate Cox proportional hazards regression model identified a high tumor growth rate (≥-11.7%/month) (HR=2.153, P=0.006) and the presence of porta vein tumor thrombosis(PVTT) (HR=1.942, P=0.006) as independent predictors of diminished OS post-TACE in patients with huge HCC. Conversely subsequent combination therapy emerged as a protective factor(HR=0.532, P=0.026). Of all patients, 57 (58.16%) received follow-up therapy. For the low tumor growth rate group, combination therapy did not significantly affect OS(P=0.477). Yet, for the high tumor growth rate cohort, post-TACE OS was notably improved in those receiving subsequent combination therapy compared to those without(χ²=4.312,P=0.038). Conclusion Tumor growth rate hodls a discernible prognostic value for patients with huge HCC undergoing TACE as the initial treatment. Those exhibiting a higher tumor growth rate tend to have a relatively poorer prognosis. Notably, patients with a rapid tumor growth rate derive greater benefit from subsequent combination therapy following TACE.

Key words: Huge hepatocellular carcinoma, Tumor growth rate, Transcatheter arterial chemoembolization, prognosis

CHEN Zong-jie, PENG Xin-jian, WANG Yu-lin, HU Tian-song. Assessing the prognostic significance of tumor growth rate in patients with huge hepatocellular carcinoma undergoing transcatheter arterial chemoembolization[J]. Chinese Hepatolgy, 2024, 29(1): 85-90.

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