Observational Study
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World J Gastroenterol. Jun 14, 2014; 20(22): 6995-7004
Published online Jun 14, 2014. doi: 10.3748/wjg.v20.i22.6995
Risk factors and therapeutic results of early local recurrence after transcatheter arterial chemoembolization
Woo Sun Rou, Byung Seok Lee, Hee Seok Moon, Eaum Seok Lee, Seok Hyun Kim, Heon Young Lee
Woo Sun Rou, Byung Seok Lee, Hee Seok Moon, Eaum Seok Lee, Seok Hyun Kim, Heon Young Lee, Division of Gastroenterology, Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon 301-721, South Korea
Author contributions: Lee BS contributed to the conception, design, analysis, and supervision of the study; Rou WS performed the research, designed the study, analyzed the data, and wrote the manuscript; Moon HS and Lee ES contributed to the analysis and discussion; Kim SH and Lee HY contributed to the discussion and review of the manuscript.
Correspondence to: Byung Seok Lee, Professor, Division of Gastroenterology, Department of Internal Medicine, Chungnam National University College of Medicine, 282 Munwha-ro, Jung-gu, Daejeon 301-721, South Korea. gie001@cnuh.co.kr
Telephone: +82-42-2807125 Fax: +82-42-2544553
Received: November 20, 2013
Revised: January 27, 2014
Accepted: March 7, 2014
Published online: June 14, 2014
Abstract

AIM: To identify factors affecting early local recurrence after transcatheter arterial chemoembolization (TACE) and investigate treatments and outcomes for local recurrence.

METHODS: Early local recurrence and no early local recurrence groups drawn from 134 patients who were initially diagnosed with hepatocellular carcinoma (HCC) and showed a complete response (CR) to TACE treatment between January 1, 2006, and January 31, 2012, were analyzed by univariate and multivariate analyses. Additionally, the subsequent treatment for patients with recurrence was analyzed, and in cases in which TACE had been performed, the cumulative recurrence rates were calculated using the Kaplan-Meier method and compared with those of the primary lesion.

RESULTS: The 1-, 2-, and 3-year survival rates were 92.3%, 60.2%, and 39.8%, respectively, in the early local recurrence group, which were significantly lower than those in both the late local and no local recurrence groups (P < 0.001). On multivariate analyses, non-compact lipiodol uptake, large tumor size, and an alpha-fetoprotein > 20 ng/mL after achieving a CR were significant predictors. When TACE was performed for early and late locally recurrent lesions, a CR was observed in 15 patients (41.7%) and 11 patients (78.6%), and the cumulative recurrence rates at 6, 12, and 24 mo were 17.9%, 43.3%, and 71.2%, respectively, which did not differ significantly from those after the first CR of 20.5%, 44.0%, and 58.6%, respectively (P = 0.639).

CONCLUSION: Closer monitoring and active treatments must be provided to patients with risk factors for early local recurrence of HCC.

Keywords: Chemoembolization, Hepatocellular carcinoma, Recurrence, Survival, Lipiodol

Core tip: We analyzed the risk factors for early local recurrence following transcatheter arterial chemoembolization (TACE) and investigated the treatment method and therapeutic results for local recurrence. This study showed that patients with early local recurrence had significantly lower survival rates and unfavorable treatment responses to repetitive TACE. Therefore, careful follow-up is believed to be necessary in patients exhibiting risk factors for early local recurrence, such as non-compact lipiodol uptake, large tumors, and an alpha-fetoprotein level > 20 ng/mL. Moreover, there was a small chance of a complete response after TACE, and considering other treatments or combining multiple treatments would therefore be advisable.