J Liver Cancer.  2023 Mar;23(1):177-188. 10.17998/jlc.2023.03.04.

Subclassification of advanced-stage hepatocellular carcinoma with macrovascular invasion: combined transarterial chemoembolization and radiotherapy as an alternative first-line treatment

• Jin S
• Choi WM
• Shim JH
• Lee D
• Kim KM
• Lim YS
• Lee HC
• Jung J
• Yoon SM
• Choi J

• KMID: 2540830
• DOI: http://doi.org/10.17998/jlc.2023.03.04

Abstract

Background
/Aim: The Barcelona Clinic Liver Cancer (BCLC) guidelines recommend systemic therapy as the only first-line treatment for patients with BCLC stage C hepatocellular carcinoma (HCC) despite its heterogeneity of disease extent. We aimed to identify patients who might benefit from combined transarterial chemoembolization (TACE) and radiation therapy (RT) by subclassifying BCLC stage C.
Methods
A total of 1,419 treatment-naïve BCLC stage C patients with macrovascular invasion (MVI) who were treated with combined TACE and RT (n=1,115) or systemic treatment (n=304) were analyzed. The primary outcome was overall survival (OS). Factors associated with OS were identified and assigned points by the Cox model. The patients were subclassified into three groups based on these points.
Results
The mean age was 55.4 years, and 87.8% were male. The median OS was 8.3 months. Multivariate analysis revealed a significant association of Child-Pugh B, infiltrative-type tumor or tumor size ≥10 cm, main or bilateral portal vein invasion, and extrahepatic metastasis with poor OS. The sub-classification was categorized into low (point ≤1), intermediate (point=2), and high (point ≥3) risks based on the sum of points (range, 0–4). The OS in the low, intermediate, and high-risk groups was 22.6, 8.2, and 3.8 months, respectively. In the low and intermediate-risk groups, patients treated with combined TACE and RT exhibited significantly longer OS (24.2 and 9.5 months, respectively) than those who received systemic treatment (6.4 and 5.1 months, respectively; P<0.0001).
Conclusions
Combined TACE and RT may be considered as a first-line treatment option for HCC patients with MVI when classified into low- and intermediate-risk groups.

Keyword

BCLC stage C; Radiotherapy; Chemotherapy; Carcinoma, hepatocellular

Figure

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  Figure 1. Overall survival of patients with hepatocellular carcinoma and macrovascular invasion according to the subclassification.

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  Figure 2. Overall survival of patients with hepatocellular carcinoma and macrovascular invasion according to the treatment. (A) Transarterial chemoembolization and radiation treatment. (B) Systemic treatment.

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  Figure 3. Overall survival of patients. (A) Low-risk group, entire population. (B) Intermediate-risk group, entire population. (C) High-risk group, entire population. (D) Low-risk group, propensity score-matching analysis. (E) Intermediate-risk group, propensity score-matching analysis. (F) High-risk group, propensity score-matching analysis.

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Reference

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