Observational Study
Copyright ©The Author(s) 2020.
World J Hepatol. Jan 27, 2020; 12(1): 21-33
Published online Jan 27, 2020. doi: 10.4254/wjh.v12.i1.21
Table 1 Clinical characteristics according to objective response - target lesion response
VariableNR (n = 44)RE (n = 141)Total (n = 185)P value
Gender (male), n (%)39 (88.6)118 (83.7)157 (84.9)0.424
Age (yr), mean ± SD58.7 ± 9.257.4 ± 8.157.7 ± 8.40.3631
BMI, mean ± SD27.2 ± 4.227 ± 4.827.1 ± 4.70.7171
Systemic hypertension, n (%)19 (43.2)60 (42.6)79 (42.7)0.941
DM, n (%)17 (38.6)46 (32.6)63 (34.1)0.463
DLP, n (%)1 (2.3)9 (6.4)10 (5.4)0.4562
Smoker (%)12 (27.3)28 (19.9)40 (21.6)0.297
Coagulopathy3, 4, n (%)21 (47.7)63 (44.7)84 (45.4)0.723
Thrombocitopenia5, n (%)28 (63.6)93 (66)121 (65.4)0.778
CHILD, n (%)0.7056
A19 (45.2)72 (52.6)91 (50.8)
B20 (47.6)56 (40.9)76 (42.5)
C3 (7.1)9 (6.6)12 (6.7)
MELD, mean ± SD12.1 ± 3.511.9 ± 3.512 ± 3.50.6051
Downstaging7 - Milan Criteria, n (%)9 (20.5)45 (31.9)54 (29.2)0.144
Multinodular HCC, n (%)19 (43.2)68 (48.2)87 (47)0.558
χ2-test.
1Student’s t-test;
2Fisher’s exact test;
3Can’t calculate;
4Patients with INR > 1.2[19];
5Patients with serum platelet counts < 150.000/mm3[20];
6Probability ratio test;
7Patients undergoing neoadjuvant liver transplant treatment excluded from the Milan Criteria. NR: Non-responder; RE: Responder; BMI: Body mass index; DM: Diabetes mellitus; DLP: Dyslipidemia; CHILD: Child-Turcotte-Pugh classification; MELD: Model for end-stage liver disease; DEB-TACE: Drug-eluting beads transarterial chemoembolization; INR: International normalized ratio; HCC: Hepatocellular carcinoma.
Table 2 Pre procedure laboratory characteristics according to objective response - target lesion response (mRECIST)
VariableNR (n = 44)RE (n = 141)Total (n = 185)P value
Hb (g/dL)12.9 ± 2.512.9 ± 212.9 ± 2.10.6671
Ht (%)37.1 ± 6.737.4 ± 5.637.3 ± 5.90.8621
Creatinine (mg/dL)0.95 ± 0.810.92 ± 0.860.93 ± 0.840.4591
Albumin (g/dL)3.43 ± 0.533.34 ± 0.553.37 ± 0.540.5751
Alphafetoprotein (UI/mL)200.3 ± 463435.1 ± 2307.2379.3 ± 2027.70.3201
Direct bilirubin (mg/dL)0.73 ± 0.490.65 ± 0.410.67 ± 0.430.6481
Indirec bilirubina (mg/dL)1.43 ± 0.871.14 ± 0.711.21 ± 0.760.0501
Total bilirubin (mg/dL)1.9 ± 1.111.78 ± 0.891.81 ± 0.940.8421
INR1.31 ± 0.191.31 ± 0.211.31 ± 0.20.7781
Platelets (x 103/mm3)85 ± 42.991.7 ± 54.890.1 ± 52.10.8101
AST (U/L)87 ± 68.184.4 ± 5985.1 ± 61.30.8421
ALT (U/L)71.4 ± 52.471.5 ± 49.771.5 ± 50.20.8251
1Student's t-test. NR: Non-responder; RE: Respondent; Hb: Hemoglobin; Ht: Hematocrit; INR: International normalized ratio; AST: Glutamic-oxalacetic transamisnase; ALT: Glutamic-pyruvic transaminase.
Table 3 Intraoperative information according to objective response - target lesion response (mRECIST)
VariableNR (n = 44)RE (n = 141)Total (n = 185)P value
Duration (min)60.9 ± 24.964.5 ± 24.863.6 ± 24.80.3721
Radioscopy time (min)25.2 ± 11.725.2 ± 1225.2 ± 11.90.9271
Contrast volume (mL)251.8 ± 70.1249.6 ± 63.1250.1 ± 64.60.8881
1Student's t-test. NR: Non-responder; RE: Responder; Duration: Total time of chemoembolization procedure; Radioscopy time: Radioscopy time of the chemoembolization procedure.
Table 4 Characteristics of hepatocellular carcinoma according to objective response - nodule-based analysis (mRECIST)
VariableNR (n = 93)RE (n = 205)Total (n = 298)P value
Preoperative
HCC diameter (cm)2.2 (1; 8.5)2.7 (1.1; 8)2.5 (1; 8.5)< 0.0011
Liver segment2, n (%)0.9613
12 (2.2)4 (2)6 (2)
28 (8.6)24 (11.7)32 (10.7)
35 (5.4)15 (7.3)20 (6.7)
410 (10.8)18 (8.8)28 (9.4)
59 (9.7)23 (11.2)32 (10.7)
619 (20.4)35 (17.1)54 (18.1)
723 (24.7)46 (22.4)69 (23.2)
817 (18.3)40 (19.5)57 (19.1)
Pseudocapsule, n (%)47 (50.5)149 (72.7)196 (65.8)< 0.001
Intraoperative
Chemoembolic dosis (mg)11.4 (1.5; 50)22.5 (2.4; 100)18.23 (1.5; 100)< 0.0011
Feeding vessels0.0411
mean ± SD1.2 ± 0.41.3 ± 0.51.2 ± 0.5
median (min; max)1 (1; 3)1 (1; 3)1 (1; 3)
Selective catheterization@, n (%)0.1973
Proximal3 (3.4)9 (5.2)12 (4.6)
Segmental33 (37.9)47 (27.2)80 (30.8)
Subsegmental51 (58.6)117 (67.6)168 (64.6)
Hypervascular4, n (%)70 (75.3)156 (78.8)226 (77.7)0.502
End-point5, n (%)88 (94.6)187 (91.2)275 (92.3)0.308
1Mann-Whitney test;
2Liver segmentation according to Couinaud;
3Likelihood ratio test;
4Hepatocellular carcinoma identified as hypervascular during hepatic angiography;
5Hepatocellular carcinoma that obtained vascular stasis during the first chemoembolization session. NR: Non-responder; RE: Responder; HCC: Hepatocellular carcinoma.
Table 5 Objective response – nodule-based analysis (mRECIST) – responder
VariableOR95%CI
P value
InferiorSuperior
Chemoembolic dose (mg)1.041.021.06< 0.001
Pseudocapsule2.011.183.420.01
Multiple logistic regression.
Table 6 Characteristics of lesion according to percentage of necrosis - hepatocellular carcinoma treated
VariableDescriptionP value
HCC diameter (cm)10.21< 0.001
Chemoembolic dose (mg)10.31< 0.001
Feeding vessel10.0930.11
Liver segment20.7093
141.7 ± 49.2
260.9 ± 43.6
364 ± 38.9
453 ± 42.4
547.3 ± 42
650 ± 43.6
756.2 ± 41.3
859.3 ± 43.2
Pseudocapsule< 0.0014
No39.2 ± 43.8
Yes63.4 ± 39.2
Selective catheterization50.0383
Proximal70.4 ± 43.9
Segmental46.3 ± 41.6
Subsegmental59.1 ± 41.9
Hypervascular60.9883
No54.4 ± 43.6
Yes54.3 ± 42.2
End point70.1983
No66.1 ± 37.7
Yes54.2 ± 42.6
1Pearson's correlation;
2Liver segmentation according to Couinaud;
3ANOVA;
4Student t-test;
5Selective catheterization levels for hepatic chemoembolization (Proximal: right/left hepatic artery trunk; Segmental: right/left hepatic artery segmental branch; Subsegmental: right/left hepatic artery subsegmental branch);
6Hepatocellular carcinoma identified as hypervascular during hepatic angiography;
7Hepatocellular carcinoma that obtained vascular stasis during the first chemoembolization session. Data expressed as mean ± SD. HCC: Hepatocellular carcinoma.
Table 7 Radiological response – % Necrosis – treated hepatocellular carcinoma
VariableCoefficientStandard-errort valueP value
Constant27.834.646< 0.001
Chemoembolic dose (mg)0.650.144.58< 0.001
Pseudocapsule18.2753.66< 0.001
Multiple linear regression.