Survival in Patients Treated with Trans Arterial Chemo Embolization (TACE) for Unresectable Hepatocellular Carcinoma and Comparison of RECIST, WHO and EASL Criteria in Determining Tumor Response: 344

Purpose: This study aims to highlight tumor response and survival in patients with unresectable hepatocellular carcinoma (HCC) receiving TACE and the correlation between RECIST, WHO, and EASL criteria in determining tumor response. Methods: We analyzed retrospectively our outcomes using TACE (doxorubicin and lipiodol) for unresectable HCC in 60 patients who were seen from January 2001 to December 2008. Demographics, presentation, etiology and treatment details were recorded for each patient. Tumors were measured in 1D, 2D and 3D (assuming spherical) and objective tumor response determined using RECIST (1D), WHO (2D) and EASL (tumor necrosis) criteria. Patients were followed until death, transplant, failure of response or treatment failure with maximum follow-up of 7 years. Results: Reporting complete data on 60 patients with 3 patients transplanted immediately post-TACE, 3 died from treatment complications and 1 lost to follow-up. Mean number of TACE per patient was 2.5±1.8 (1-8 interventions). At presentation, mean tumor diameter was 6.9±4.4 cm (1.3-20.4 cm) and 26 patients (43%) were Child-Pugh (CP) A, 25 (42%) were CP B, 1 (1.7%) was CP C and the remaining unknown. The mean MELD score was 8.5±3 points (4-17 points). Tumor response according to RECIST, WHO and EASL criteria are shown in Table 1 and most patients displayed stable disease. Overall mean survival time after first TACE was 20±2.2 months (95% CI, 11.8-26.8). Using WHO classification, mean survival in Partial Response (PR) & Stable Disease (SD) was 20.5±2.4 m (95% CI, 15.7-25.2), and in Progressive Disease (PD) was 16.9±4.4 m (95% CI, 8.4-25.5). Similar results were found using RECIST: PR & SD was 20.9±2.4 m (95% CI, 16.2-25.6), and in PD was 11.8±7.2 m (95% CI, 1.0-25.9); and EASL: PR & SD was 20.5±2.4 m (95% CI, 15.7-25.3), and in PD was 11.8±7.2 m (95% CI, 1.0-25.9). Pearson correlation coefficients between 1D, 2D and 3D measurements and between RECIST, WHO and EASL for tumor response assessment are presented in Table 2. Correlations were equally high between 1D vs. 2D, 1D vs. 3D and 2D vs. 3D measurements and concordance was best between RECIST and WHO and weakest between RECIST and WHO vs. EASL in tumor response assessment.Table 1Table 2Conclusion: TACE prolongs survival and stabilizes tumor growth in patients with unresectable HCC. Survival is better in patients who achieved PR & SD compared to patients who had PD, regardless of the classification used (WHO, RECIST or EASL). There is good concordance between 1D, 2D and 3D measurements of HCC and between RECIST and WHO criteria, but not EASL, in determining tumor response to TACE.