Initial Trans-Arterial Chemo-Embolisation (TACE) Is Associated with Similar Survival Outcomes as Compared to Upfront Percutaneous Ablation Allowing for Follow-Up Treatment in Those with Single Hepatocellular Carcinoma (HCC) ≤ 3 cm: Results of a Real-

Percutaneous ablation is recommended in Barcelona Clinic Liver Cancer (BCLC) stage 0/A patients with HCC ≤3 cm as a curative treatment modality alongside surgical resection and liver transplantation. However, trans-arterial chemo-embolisation (TACE) is commonly used in the real-world as an initial treatment in patients with single small HCC in contrast to widely accepted clinical practice guidelines which typically describe TACE as a treatment for intermediate-stage HCC. We performed this real-world propensity-matched multi-centre cohort study in patients with single HCC ≤ 3 cm to assess for differences in survival outcomes between those undergoing initial TACE and those receiving upfront ablation. Patients with a new diagnosis of BCLC 0/A HCC with a single tumour ≤3 cm first diagnosed between 1 January 2016 and 31 December 2020 who received initial TACE or ablation were included in the study. A total of 348 patients were included in the study, with 147 patients receiving initial TACE and 201 patients undergoing upfront ablation. After propensity score matching using key covariates, 230 patients were available for analysis with 115 in each group. There were no significant differences in overall survival (log-rank test <i>p</i> = 0.652) or liver-related survival (log-rank test <i>p</i> = 0.495) over a median follow-up of 43 months. While rates of CR were superior after ablation compared to TACE as a first treatment (74% vs. 56%, <i>p</i> < 0.004), there was no significant difference in CR rates when allowing for further subsequent treatments (86% vs. 80% <i>p</i> = 0.219). In those who achieved CR, recurrence-free survival and local recurrence-free survival were similar (log rank test <i>p</i> = 0.355 and <i>p</i> = 0.390, respectively). Our study provides valuable real-world evidence that TACE when offered with appropriate follow-up treatment is a reasonable initial management strategy in very early/early-stage HCC, with similar survival outcomes as compared to those managed with upfront ablation. Further work is needed to better define the role for TACE in BCLC 0/A HCC.

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Journal
Cancers
Published
2024-08-29
DOI
https://doi.org/10.3390/cancers16173010
Citations
5
Primary Topic
Hepatocellular Carcinoma Treatment and Prognosis
Type
article
Field-Weighted Citation Impact
1.85

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article

Initial Trans-Arterial Chemo-Embolisation (TACE) Is Associated with Similar Survival Outcomes as Compared to Upfront Percutaneous Ablation Allowing for Follow-Up Treatment in Those with Single Hepatocellular Carcinoma (HCC) ≤ 3 cm: Results of a Real-

Kathryn Gazelakis, Elysia Greenhill, Daniel Saitta, Zina Valaydon et al.
5 citations
Cancers
Hepatocellular Carcinoma Treatment and Prognosis
1.85
article

Initial Trans-Arterial Chemo-Embolisation (TACE) Is Associated with Similar Survival Outcomes as Compared to Upfront Percutaneous Ablation Allowing for Follow-Up Treatment in Those with Single Hepatocellular Carcinoma (HCC) ≤ 3 cm: Results of a Real-

Kathryn Gazelakis, Elysia Greenhill, Daniel Saitta, Zina Valaydon, Stuart Keith Roberts, John Raymond Zalcberg, Avik Majumdar, Nicholas Batt, Merlyn Joseph, Amanda Nicoll, Kate Collins, Nicholas Hannah, Steven J. Bollipo, Rohit Sawhney, Jessica Howell, Jonathan Abdelmalak, William Kemp, Joshua Haron Abasszade, John Lubel, Jacinta Alison Holmes, Siddharth Sood, Ammar Majeed, Myo J. Tang, Natalie Ngu, Marie J. Sinclair, Anouk Dev, Stephen M. Riordan, Claude V. Dennis, James Haridy, Simone Irene Strasser, Dhivya Pandiaraja, Alex J. Thompson, Eileen Lam, Suresh Sharma, Katherine Bateman, Susan Byers
article en
5 citations

Abstract

Percutaneous ablation is recommended in Barcelona Clinic Liver Cancer (BCLC) stage 0/A patients with HCC ≤3 cm as a curative treatment modality alongside surgical resection and liver transplantation. However, trans-arterial chemo-embolisation (TACE) is commonly used in the real-world as an initial treatment in patients with single small HCC in contrast to widely accepted clinical practice guidelines which typically describe TACE as a treatment for intermediate-stage HCC. We performed this real-world propensity-matched multi-centre cohort study in patients with single HCC ≤ 3 cm to assess for differences in survival outcomes between those undergoing initial TACE and those receiving upfront ablation. Patients with a new diagnosis of BCLC 0/A HCC with a single tumour ≤3 cm first diagnosed between 1 January 2016 and 31 December 2020 who received initial TACE or ablation were included in the study. A total of 348 patients were included in the study, with 147 patients receiving initial TACE and 201 patients undergoing upfront ablation. After propensity score matching using key covariates, 230 patients were available for analysis with 115 in each group. There were no significant differences in overall survival (log-rank test <i>p</i> = 0.652) or liver-related survival (log-rank test <i>p</i> = 0.495) over a median follow-up of 43 months. While rates of CR were superior after ablation compared to TACE as a first treatment (74% vs. 56%, <i>p</i> < 0.004), there was no significant difference in CR rates when allowing for further subsequent treatments (86% vs. 80% <i>p</i> = 0.219). In those who achieved CR, recurrence-free survival and local recurrence-free survival were similar (log rank test <i>p</i> = 0.355 and <i>p</i> = 0.390, respectively). Our study provides valuable real-world evidence that TACE when offered with appropriate follow-up treatment is a reasonable initial management strategy in very early/early-stage HCC, with similar survival outcomes as compared to those managed with upfront ablation. Further work is needed to better define the role for TACE in BCLC 0/A HCC.

CancersVol. 16(17)
The Royal Melbourne Hospital (AU), The University of Melbourne (AU), Royal Prince Alfred Hospital (AU), Austin Hospital (AU), John Hunter Hospital (AU), St Vincent's Hospital Melbourne (AU), Eastern Health (AU), Prince of Wales Hospital (AU), Footscray Hospital (AU), Western Health (AU), Monash Health (AU), Alfred Health (AU), Monash University (AU)
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Good health and well-being
Openalex Percentile: Top 14%
Hepatocellular Carcinoma Treatment and Prognosis
1.85
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