Abdominal Radiology

, Volume 44, Issue 10, pp 3463–3479 | Cite as

Correlation between SACE (Subjective Angiographic Chemoembolization Endpoint) score and tumor response and its impact on survival after DEB-TACE in patients with hepatocellular carcinoma

  • Victoria Susanne Antonia HabbelEmail author
  • Martin Zeile
  • Gregor Alexander Stavrou
  • Frank Wacker
  • Roland Brüning
  • Karl-Jürgen Oldhafer
  • Thomas Rodt
Interventional Radiology



To asses angiographic and computed tomographic success criteria during and after transcatheter arterial drug-eluting bead chemoembolization (DEB-TACE) in patients with hepatocellular carcinoma (HCC) and its impact on progression-free survival (PFS) and overall survival (OS).


In this retrospective single-center study, 50 patients with unresectable HCC having undergone DEB-TACE from January 2010 to July 2015 were assessed. The angiographic endpoint was classified by Subjective Angiographic Chemoembolization Endpoint (SACE) scale. Relative tumor density in arterial (DArt) and portal venous phase (DPV) computed tomography post- versus pre-DEB-TACE were calculated, respectively. Tumor response according to modified Response Criteria in Solid Tumors (mRECIST) was assessed. Univariate Kaplan–Meier and Cox regression analysis were carried out.


SACE scores I, II, III, and IV were found in 1 (2%), 20 (40%), 15 (30%), and 14 (28%) patients, respectively. Median OS and PFS were 14.2 and 5.5 months, respectively. Death rates at 6 months, 1 year and 2 years were 24%, 38%, and 52%, respectively. SACE score during DEB-TACE significantly correlated with local and overall mRECIST results (local: p < 0.001, r = 0.49, overall: p = 0.042, r = 0.29) and inversely correlated with DPV (p = 0.005, r = − 0.40). In univariate analysis, progressive disease (PD) according to mRECIST and increase of DArt and DPV were associated with significantly shorter PFS. Modified RECIST independently predicted OS (hazard ratio for complete remission vs. PD = 0.15, 95% confidence interval 0.03–0.68, p = 0.014).


A direct impact of SACE on PFS or OS could not be shown. However, SACE significantly correlated with local and overall mRECIST tumor response that again significantly predicted OS. We therefore postulate an indirect impact of SACE on OS. Consequently, complete embolization should be attempted.


Hepatocellular carcinoma Transcatheter arterial drug-eluting bead chemoembolization TACE Subjective Angiographic Chemoembolization Endpoint scale SACE Tumor density mRECIST 



The authors would like to thank PD Dr. Med. Bruno Neuner, Campus Virchow-Hospital, Charité Berlin, as well as Sebastian Häckl and Florian Lasch, Institute for Biometry, Hannover Medical School for their statistical guidance throughout the study.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This study was reviewed and approved by the Ethical Committee of Hannover Medical School, Germany.


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© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of General and Visceral Surgery and Surgical OncologyAsklepios Klinik BarmbekHamburgGermany
  2. 2.Semmelweis Medical FacultyAsklepios Campus HamburgHamburgGermany
  3. 3.Department of Diagnostic and Interventional RadiologyMarienkrankenhaus GmbHHamburgGermany
  4. 4.Department of General, Visceral, Thoracic and Pediatric SurgeryKlinikum SaarbrückenSaarbrückenGermany
  5. 5.Department of Diagnostic and Interventional RadiologyHannover Medical SchoolHannoverGermany
  6. 6.Department of Diagnostic and Interventional RadiologyAsklepios Klinik BarmbekHamburgGermany
  7. 7.Department of Diagnostic and Interventional Radiology / Neuroradiology and Nuclear MedicineKlinikum LueneburgLüneburgGermany

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