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23.07.2019 | Interventional Radiology

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

verfasst von: Victoria Susanne Antonia Habbel, Martin Zeile, Gregor Alexander Stavrou, Frank Wacker, Roland Brüning, Karl-Jürgen Oldhafer, Thomas Rodt

Erschienen in: Abdominal Radiology | Ausgabe 10/2019

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Abstract

Purpose

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).

Methods

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 (D_Art) and portal venous phase (D_PV) 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.

Results

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 D_PV (p = 0.005, r = − 0.40). In univariate analysis, progressive disease (PD) according to mRECIST and increase of D_Art and D_PV 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).

Conclusions

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.

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Titel: Correlation between SACE (Subjective Angiographic Chemoembolization Endpoint) score and tumor response and its impact on survival after DEB-TACE in patients with hepatocellular carcinoma
verfasst von: Victoria Susanne Antonia Habbel
Martin Zeile
Gregor Alexander Stavrou
Frank Wacker
Roland Brüning
Karl-Jürgen Oldhafer
Thomas Rodt
Publikationsdatum: 23.07.2019
Verlag: Springer US
Erschienen in: Abdominal Radiology / Ausgabe 10/2019
Print ISSN: 2366-004X
Elektronische ISSN: 2366-0058
DOI: https://doi.org/10.1007/s00261-019-02128-7

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