Background Conventional transarterial chemoembolization (cTACE) has emerged as a major treatment modality
for unresectable hepatocellular carcinoma (HCC). Efforts have recently been made to identify biomarkers of HCCs
that can potentially predict the response of lesions to transarterial chemoembolization (TACE) therapy. The goal
of these efforts is to simplify the decision-making process on whether a patient should choose cTACE or pursue other
treatment options. Among these, computed tomography (CT) based lipiodol retention analysis has shown promise
in providing valuable insights into post-TACE outcomes. This study aimed to investigate the value of CT-based lipiodol
retention pattern in predicting recurrence after a state of complete response (CR) according to modified Response
Evaluation Criteria in Solid Tumors (mRECIST) guideline post-cTACE.
Methods From January 2022 to June 2023, a cohort of 30 patients with 40 HCCs who received a primary cTACE
session were identified. The study included patients who underwent 1st cTACE session with no more than three
HCCs. Ten HCC lesions were eliminated owing to different reasons (illustrated in the flow chart). Tumor response
was evaluated based on mRECIST on 1st follow-up CT with a particular focus on tumors demonstrating a complete
response. Patterns of lipiodol retention within these tumors were categorized as complete lipiodol retention
pattern (C-Lip), covering the whole tumor, or incomplete lipiodol retention pattern (I-Lip). Recurrence was defined
when reappearance of enhancement on arterial-phase images of the treated lesion with subsequent washout
on portal/delayed phase images occurred corresponding to findings of restricted diffusion on follow-ups DCE-MRI.
Results A total of 30 HCCs with a CR were classified into 21 (70%) with C-Lip and 9 (30%) with I-Lip. After a median
follow-up of 6.00 ± 2.27 months (3–9 months), 8/9 (88.9%) I-Lip and 5/21 (23.8%) C-Lip showed recurrence
on follow-up (DCE-MRI), (p < 0.01), with no significant difference in the time of progression (mean 5.57 ± 2.69 for C-Lip
vs. 6.00 ± 2.27 months for I-Lip, with (p < 0.5). |
