Real-life efficacy and safety profile of TACE in patients with intermediate HCC in a large German cohort

Introduction:

Transarterial chemoembolization (TACE) is the standard of care for patients with locally advanced hepatocellular carcinoma (HCC). A recent meta-analysis demonstrated a median overall survival (OS) of 19.4 months and most common intervention-related adverse events included postembolization syndrome (PES)-associated symptoms in up to 47%. The aim of this study was to validate the TACE intervention in terms of outcome and safety profile in large German cohort over a period of 10 years.

Methods and Patients:

Within this retrospective analysis we reviewed electronic charts of 987 patients diagnosed with HCC, who were treated between January 2008 and October 2017. Finally, 321 patients received TACE in palliative intention and were eligible for final analysis. Data of risk-factors, liver function, BCLC stage, ECOG, laboratory values, radiological findings, treatment modalities, and follow-up were recorded until 31.10.2017. Primary outcomes were median OS. Secondary endpoints were safety-profile of the intervention in terms of PES and median OS depending on Child-Pugh-status (CPS), ECOG, and BCLC-status.

Results:

The median OS in the complete cohort was 19.0 months. The median OS in patients classified Child A demonstrated a prolonged OS of 19.8 months compared to Child B with 8.6 months (p < 0.0001). OS-data in dependence of the ECOG at treatment-start were as follows: ECOG 0 22.3 months, ECOG 1 13.0 months, ECOG 2 9.2 months (p < 0.0005). Finally, we analyzed patients with respect to the BCLC-stage: BCLC B 16.8 months and BCLC C 8.7 months (p < 0.002). During 1064 TACE interventions 528 cases (49.6%) of intervention-related adverse events occurred. The PES was present after 335 procedures (36.0%) compared to 47.7% annotated by the comprehensive meta-analysis by Lencioni et al. Of note and as expected, intervention-related adverse events occurred significantly more frequent after non-selective interventions (48.8% vs. 40.1%; p < 0.05).

Conclusion:

Our data demonstrated a comparable outcome compared to the most recent comprehensive literature. Notably, Child B and ECOG 2 patients were exposed to a substantial dismal prognosis, leading to critical discussion of TACE-indication and switching to alternative treatment options. The tolerability in terms of PES was markedly less common as indicated by the literature and non-selective TACE is significantly associated with higher rates of intervention-related adverse events.