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Journal of Oncology
Volume 2016, Article ID 4692139, 8 pages
http://dx.doi.org/10.1155/2016/4692139
Clinical Study

Does the Degree of Hepatocellular Carcinoma Tumor Necrosis following Transarterial Chemoembolization Impact Patient Survival?

1University of Alabama at Birmingham School of Medicine, Birmingham, AL 35233, USA
2Biostatistics Division, School of Public Health, University of Alabama at Birmingham, Birmingham, AL 35233, USA
3Department of Radiology, University of Alabama at Birmingham, Birmingham, AL 35233, USA
4Liver Transplant and Hepatobiliary Surgery, University of Alabama at Birmingham, Birmingham, AL 35233, USA

Received 25 September 2015; Revised 21 December 2015; Accepted 29 December 2015

Academic Editor: Kalpesh Jani

Copyright © 2016 Nathan Haywood et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose. The association between transarterial chemoembolization- (TACE-) induced HCC tumor necrosis measured by the modified Response Evaluation Criteria In Solid Tumors (mRECIST) and patient survival is poorly defined. We hypothesize that survival will be superior in HCC patients with increased TACE-induced tumor necrosis. Materials and Methods. TACE interventions were retrospectively reviewed. Tumor response was quantified via dichotomized (responders and nonresponders) and the four defined mRECIST categories. Results. Median survival following TACE was significantly greater in responders compared to nonresponders (20.8 months versus 14.9 months, ). Survival outcomes also significantly varied among the four mRECIST categories (): complete, 21.4 months; partial, 20.8; stable, 16.8; and progressive, 7.73. Only progressive disease demonstrated significantly worse survival when compared to complete response. Multivariable analysis showed that progressive disease, increasing total tumor diameter, and non-Child-Pugh class A were independent predictors of post-TACE mortality. Conclusions. Both dichotomized (responders and nonresponders) and the four defined mRECIST responses to TACE in patients with HCC were predictive of survival. The main driver of the survival analysis was poor survival in the progressive disease group. Surprisingly, there was small nonsignificant survival benefit between complete, partial, and stable disease groups. These findings may inform HCC treatment decisions following first TACE.