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Transarterial Chemoembolization of Hepatocellular Carcinoma: Propensity Score Matching Study Comparing Survival and Complications in Patients with Nonalcoholic Steatohepatitis Versus Other Causes Cirrhosis

  • Clinical Investigation
  • Interventional Oncology
  • Published:
CardioVascular and Interventional Radiology Aims and scope Submit manuscript

Abstract

Purpose

To evaluate the oncologic outcomes and complication profile in nonalcoholic steatohepatitis (NASH)-induced cirrhosis leading to hepatocellular carcinoma (HCC) treated with transarterial chemoembolization (TACE).

Materials and Methods

Two hundred and twenty patients who underwent treatment of 353 HCCs were retrospectively reviewed, including 30 NASH patients who received TACE for 46 HCCs. Patient charts were evaluated for time to progression (TTP), complications and overall survival (OS). The group was split into NASH and non-NASH cohorts for comparison and additional analyses were done using propensity score matching (PSM).

Results

Patients in the NASH cohort presented with significantly larger lesions (4.9 ± 5.8 cm vs 3.1 ± 2.4 cm, p = 0.05). There was no significant difference in TTP overall [Median NASH 396 days (95% CI 308–526 days) vs non-NASH cohort 307 days (95% CI 272–364), p = 0.25) or after PSM [259 days non-NASH (95% CI 215–490) vs 396 days NASH (95% CI (349–not reached), p = 0.43]. There was a non-significant increased OS in the non-NASH [median 1078 days (95% CI 668–1594)] as compared to the NASH cohort [median 706 days (95% CI 314–not reached)] (p = 0.08) which decreased following PSM [853 days (95% CI 526–1511) non-NASH vs 706 days (95% CI 314–not reached) NASH, p = 0.48]. The number of complications did not differ significantly between the two groups (p = 0.23).

Conclusion

The oncologic outcomes and complication profile of TACE for HCC induced by NASH cirrhosis appear to be similar to that of other etiologies of cirrhosis. NASH patients presented with larger tumors emphasizing the need for early surveillance.

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References

  1. Younossi Z, Henry L. Contribution of alcoholic and nonalcoholic fatty liver disease to the burden of liver-related morbidity and mortality. Gastroenterology. 2016;150(8):1778–85. https://doi.org/10.1053/j.gastro.2016.03.005.

    Article  PubMed  Google Scholar 

  2. Younossi ZM, Marchesini G, Pinto-Cortez H, et al. Epidemiology of nonalcoholic fatty liver disease and nonalcoholic steatohepatitis: implications for liver transplantation. Transplantation. 2019;103(1):22–7. https://doi.org/10.1097/tp.0000000000002484.

    Article  PubMed  Google Scholar 

  3. Goldberg D, Ditah IC, Saeian K, et al. Changes in the prevalence of hepatitis c virus infection, nonalcoholic steatohepatitis, and alcoholic liver disease among patients with cirrhosis or liver failure on the waitlist for liver transplantation. Gastroenterology. 2017;152(5):1090-99.e1. https://doi.org/10.1053/j.gastro.2017.01.003.

    Article  Google Scholar 

  4. Tateishi R, Okanoue T, Fujiwara N, et al. Clinical characteristics, treatment, and prognosis of non-B, non-C hepatocellular carcinoma: a large retrospective multicenter cohort study. J Gastroenterol. 2015;50(3):350–60. https://doi.org/10.1007/s00535-014-0973-8.

    Article  CAS  PubMed  Google Scholar 

  5. Wong CR, Njei B, Nguyen MH, et al. Survival after treatment with curative intent for hepatocellular carcinoma among patients with vs without non-alcoholic fatty liver disease. Aliment Pharmacol Ther. 2017;46(11–12):1061–9. https://doi.org/10.1111/apt.14342.

    Article  CAS  PubMed  Google Scholar 

  6. Ohki T, Tateishi R, Shiina S, et al. Visceral fat accumulation is an independent risk factor for hepatocellular carcinoma recurrence after curative treatment in patients with suspected NASH. Gut. 2009;58(6):839–44. https://doi.org/10.1136/gut.2008.164053.

    Article  CAS  PubMed  Google Scholar 

  7. Reddy SK, Steel JL, Chen HW, et al. Outcomes of curative treatment for hepatocellular cancer in nonalcoholic steatohepatitis versus hepatitis C and alcoholic liver disease. Hepatology (Baltimore, MD). 2012;55(6):1809–19. https://doi.org/10.1002/hep.25536.

    Article  Google Scholar 

  8. Wakai T, Shirai Y, Sakata J, et al. Surgical outcomes for hepatocellular carcinoma in nonalcoholic fatty liver disease. J Gastrointest Surg Off J Soc Surg Aliment Tract. 2011;15(8):1450–8. https://doi.org/10.1007/s11605-011-1540-8.

    Article  Google Scholar 

  9. Kern B, Feurstein B, Fritz J, et al. High incidence of hepatocellular carcinoma and postoperative complications in patients with nonalcoholic steatohepatitis as a primary indication for deceased liver transplantation. Eur J Gastroenterol Hepatol. 2019;31(2):205–10. https://doi.org/10.1097/meg.0000000000001270.

    Article  PubMed  Google Scholar 

  10. Llovet JM, Real MI, Montana X, et al. Arterial embolisation or chemoembolisation versus symptomatic treatment in patients with unresectable hepatocellular carcinoma: a randomised controlled trial. Lancet (London, England). 2002;359(9319):1734–9. https://doi.org/10.1016/s0140-6736(02)08649-x.

    Article  Google Scholar 

  11. Kikuchi L, Oliveira CP, Alvares-da-Silva MR, et al. Hepatocellular carcinoma management in nonalcoholic fatty liver disease patients: applicability of the BCLC staging system. Am J Clin Oncol. 2016;39(5):428–32. https://doi.org/10.1097/coc.0000000000000134.

    Article  CAS  PubMed  Google Scholar 

  12. Siriwardana RC, Niriella MA, Dassanayake AS, et al. Factors affecting post-embolization fever and liver failure after trans-arterial chemo-embolization in a cohort without background infective hepatitis- a prospective analysis. BMC Gastroenterol. 2015;15:96. https://doi.org/10.1186/s12876-015-0329-8.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Salsamendi J, Pereira K, Kang K, et al. Minimally invasive percutaneous endovascular therapies in the management of complications of non-alcoholic fatty liver disease (NAFLD): a case report. J Radiol Case Rep. 2015;9(9):36–43. https://doi.org/10.3941/jrcr.v9i9.2557.

    Article  PubMed  PubMed Central  Google Scholar 

  14. European Association For The Study Of The Liver, European Organisation For Research And Treatment Of Cancer. EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma. Journal of hepatology. 2012;56(4):908–43. https://doi.org/10.1016/j.jhep.2011.12.001.

    Article  Google Scholar 

  15. Filippiadis DK, Binkert C, Pellerin O, et al. Cirse quality assurance document and standards for classification of complications: the cirse classification system. Cardiovasc Interv Radiol. 2017;40(8):1141–6. https://doi.org/10.1007/s00270-017-1703-4.

    Article  CAS  Google Scholar 

  16. Grigorian A, O’Brien CB. Hepatotoxicity Secondary to Chemotherapy. J Clin Transl Hepatol. 2014;2(2):95–102. https://doi.org/10.14218/jcth.2014.00011.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Zhou B, Fine J, Latouche A, et al. Competing risks regression for clustered data. Biostatistics (Oxford, England). 2012;13(3):371–83. https://doi.org/10.1093/biostatistics/kxr032.

    Article  Google Scholar 

  18. Weinmann A, Alt Y, Koch S, et al. Treatment and survival of non-alcoholic steatohepatitis associated hepatocellular carcinoma. BMC cancer. 2015;15:210. https://doi.org/10.1186/s12885-015-1197-x.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Lammer J, Malagari K, Vogl T, et al. Prospective randomized study of doxorubicin-eluting-bead embolization in the treatment of hepatocellular carcinoma: results of the PRECISION V study. Cardiovasc Interv Radiol. 2010;33(1):41–52. https://doi.org/10.1007/s00270-009-9711-7.

    Article  Google Scholar 

  20. Bouvier A, Ozenne V, Aube C, et al. Transarterial chemoembolisation: effect of selectivity on tolerance, tumour response and survival. Eur Radiol. 2011;21(8):1719–26. https://doi.org/10.1007/s00330-011-2118-2.

    Article  PubMed  Google Scholar 

  21. Guiu B, Deschamps F, Aho S, et al. Liver/biliary injuries following chemoembolisation of endocrine tumours and hepatocellular carcinoma: lipiodol vs. drug-eluting beads. J Hepatol. 2012;56(3):609–17. https://doi.org/10.1016/j.jhep.2011.09.012.

    Article  CAS  PubMed  Google Scholar 

  22. Kobayashi S, Nakanuma Y, Matsui O. Intrahepatic peribiliary vascular plexus in various hepatobiliary diseases: a histological survey. Hum Pathol. 1994;25(9):940–6. https://doi.org/10.1016/0046-8177(94)90016-7.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

Research reported in this publication was supported by NIH Grant P30 CA77598 utilizing the Biostatistics and Bioinformatics Core shared resource of the Masonic Cancer Center, University of Minnesota and by the National Center for Advancing Translational Sciences of the National Institutes of Health Award Number UL1TR000114. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Funding

This study was not supported by grant funding.

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Authors and Affiliations

  1. Department of Radiology, Division of Interventional Radiology, University of Minnesota, 420 Delaware St SE MMC 292, Minneapolis, MN, 55455, USA

    Shamar Young, Nathan Rubin, Damian Hall, Luke Roller, Yassine Charaf & Jafar Golzarian

  2. VA Department of Radiology, Minneapolis VA Health Care System, 1 Veterans Dr, Minneapolis, MN, 55417, USA

    Tina Sanghvi

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  1. Shamar Young
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  2. Tina Sanghvi
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Correspondence to Shamar Young.

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Young, S., Sanghvi, T., Rubin, N. et al. Transarterial Chemoembolization of Hepatocellular Carcinoma: Propensity Score Matching Study Comparing Survival and Complications in Patients with Nonalcoholic Steatohepatitis Versus Other Causes Cirrhosis. Cardiovasc Intervent Radiol 43, 65–75 (2020). https://doi.org/10.1007/s00270-019-02363-x

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