간세포암에 대한 간동맥 화학색전술 직후 수행된 비조영증강 전산화 단층촬영의 임상적 영향

Abstract

Background: Intratumoral lipiodol deposition following transcatheter chemoembolization (TACE) is associated with the prognosis of hepatocellular carcinoma (HCC) patients. However, there is insufficient evidence regarding the actual clinical significance of the imaging tests conducted to evaluate the lipiodol uptake after TACE. This study evaluates the clinical impact and potential utility of performing immediate post-TACE non-enhanced computed tomography (NECT) on the treatment of HCC. Methods: This retrospective study at a tertiary referral center included patients undergoing their first session of conventional TACE for initial treatment of HCC from November 2021 to December 2022. Patients were divided into two groups based on whether they received immediate post-TACE NECT: immediate-NECT group and no-immediate-NECT group. The immediate-NECT group was further categorized based on lipiodol uptake into Cohorts A (<50% uptake with additional treatment before the first follow-up one month after TACE), B (<50% uptake without additional treatment before first follow-up), and C (≥50% uptake). Survival curves for the time to progression (TTP) were estimated using the Kaplan-Meier method and were compared by using the log-rank test. Results: Out of 626 patients, 189 (30.2%) were in the immediate-NECT group. Twenty-eight patients (4.5%) showed less than 50% lipiodol uptake; two in Cohort A and 26 in Cohort B. Cohort C included 161 patients (25.7%). Cohort B had the highest rate of residual viable tumor (73.1%) one month after TACE, compared to the other cohorts (0% in Cohort A and 31.1% in Cohort C). During follow-up, no progression occurred in Cohort A. The median TTP of Cohort B was 4.6 months (95% confidence interval [CI], 2.9–15.7 months), significantly shorter than the 15.2 months (95% CI, 10.9–20.9 months) for Cohort C (p = 0.002). In the no-immediate- NECT group of 437 patients, 163 (37.3%) showed residual viable HCC one month after TACE with a median TTP of 14.5 months (95% CI, 11.3–17.2 months). Conclusions: Immediate post-TACE NECT assessment of lipiodol uptake can stratify HCC patients and facilitate early prediction of therapeutic response. Identifying suboptimal lipiodol uptake immediately after TACE can aid future treatment adjustments and potentially improving oncologic outcomes. Keywords: Hepatocellular carcinoma, Chemoembolization, Lipiodol, Computed tomography, Time to progression