Response to transarterial chemoembolization as a selection criterion for resection of hepatocellular carcinomas
Menée sur 242 patients atteints d'un carcinome hépatocellulaire de stade intermédiaire, cette étude évalue l'intérêt d'utiliser la réponse à une chimioembolisation transartérielle pour sélectionner les patients pouvant bénéficier d'une résection chirurgicale
Background : Liver resection for intermediate (Barcelona Clinic Liver Cancer (BCLC) stage B) hepatocellular carcinoma (HCC) remains controversial. This study attempted to demonstrate the effectiveness of preresection transarterial chemoembolization (TACE) as a selection criterion for BCLC-B HCC.
Methods : The study included patients with BCLC-B HCC who underwent liver resection after TACE. The tumour response to TACE was evaluated according to the modified Response Evaluation Criteria in Solid Tumours (mRECIST). Patients with a complete or partial response comprised the responder group, whereas those with stable or progressive disease were classified as non-responders.
Results : A total of 242 patients were included. After between one and eight sessions of TACE, 141 patients were included in the responder group: 37 patients (15·3 per cent) who achieved a complete response and 104 who had a partial response. The cumulative 1-, 3- and 5-year overall survival rates were 97·2, 88·7 and 75·2 per cent respectively in the responder group, compared with 90·1, 67·3 and 53·5 per cent among 101 non-responders (P < 0·001). Tumour-free survival rates were also better among responders than non-responders (P < 0·001). In multivariable analysis, independent predictors of overall and tumour-free survival were response to TACE and microvascular invasion (all P < 0·001).
Conclusion : mRECIST may represent selection criterion for intermediate HCC for surgical treatment.
British Journal of Surgery , résumé, 2015