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Original Article
- Combined Transarterial Chemoembolization and External Beam Radiotherapy for Identifying Surgical Candidates for Hepatocellular Carcinoma with Macroscopic Vascular Invasion: A Propensity Score-Weighted Analysis
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Sumin Lee1,a)
, Jinhong Jung1, Jonggi Choi2, So Yeon Kim3, Jin Hyoung Kim3, Danbi Lee2, Ju Hyun Shim2, Kang Mo Kim2, Young-Suk Lim2, Han Chu Lee2, Gi-Won Song4, Jin-hong Park1, Sang Min Yoon1
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DOI: https://doi.org/10.4143/crt.2025.076 [Accepted]
Published online: May 22, 2025
1Department of Radiation Oncology, Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
2Department of Gastroenterology, Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
3Department of Radiology and the Research Institute of Radiology, Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
4Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
a)Present address: Department of Radiation Oncology, Kangwon National University Hospital, Chuncheon, Korea
2Department of Gastroenterology, Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
3Department of Radiology and the Research Institute of Radiology, Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
4Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
a)Present address: Department of Radiation Oncology, Kangwon National University Hospital, Chuncheon, Korea
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Corresponding author:
Sang Min Yoon
Tel: 82-2-3010-5615
Email: drsmyoon@amc.seoul.kr
Received: 18 January 2025 • Accepted: 29 April 2025
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Abstract
Purpose
To evaluate the role of hepatic resection in patients with objective responses after combined transarterial chemoembolization (TACE) and radiotherapy (RT) for hepatocellular carcinoma (HCC) with macroscopic vascular invasion (MVI).
Materials and Methods
We retrospectively reviewed the patients treated with combined TACE and RT for HCC with MVI between 2010 and 2015. Some of the patients with objective responses underwent hepatic resection or liver transplantation; to investigate the impact of surgery, patients with objective responses who did not undergo surgery were selected as the control group. Survival outcomes were compared using a propensity score-based stabilized inverse probability of treatment weighting method.
Results
Out of the 170 patients with objective responses after combined TACE and RT, 41 patients underwent surgery, including 8 liver transplantations. The unweighted surgery group was younger and had a higher proportion of solitary tumors and unilateral vascular involvement. After adjustment, the 3-year overall survival (OS) rates were 61.0% and 28.6% in the surgery and non-surgery groups, respectively. The most important prognostic factor for OS was surgery (adjusted Cox hazard ratio [HR], 0.28; 95% confidence interval [CI], 0.17–0.46; p<0.001). Complete response after TACE and RT (vs. partial response) was also a significant prognostic factor for OS (adjusted HR, 0.41; 95% CI, 0.27–0.61; p<0.001). There was no surgical mortality. Four patients (9.8%) required additional surgery due to bleeding or graft failure.
Conclusion
Hepatic resection was significantly associated with improved OS in patients who showed objective responses after receiving combined TACE and RT for HCC with MVI.
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