Objective Response by mRECIST is an Independent Prognostic Factor for Overall Survival in Intermediate Hepatocellular Carcinoma Undergoing Transarterial Chemoembolization
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Background
The prognostic value of objective response assessed by the modified Response Evaluation Criteria in Solid Tumors (mRECIST) remains insufficiently characterized in patients with intermediate-stage hepatocellular carcinoma (HCC) patients undergoing transarterial chemoembolization (TACE).
Aim
This study aimed to evaluate the association between objective response and overall survival in this patient population.
Methods
A retrospective analysis was conducted on 812 patients with Barcelona Clinic Liver Cancer (BCLC) stage B HCC who received TACE as first-line therapy at a tertiary hospital in China between January 2007 and May 2012. Patients were classified as responders (complete or partial response) or non-responders (stable or progressive disease) based on mRECIST criteria at the first follow-up after TACE. Baseline characteristics, including tumor size, number, and alpha-fetoprotein levels, were recorded. Overall survival was estimated using Kaplan-Meier analysis, and potential prognostic factors were evaluated using Cox proportional hazards models.
Results
The objective response rate according to mRECIST was 63.2% (513/812). Responders demonstrated significantly longer median overall survival compared to non-responders (44.0 months vs. 10.9 months; hazards ratio [HR]: 0.31, 95% CI: 0.26–0.38; p < 0.0001). Landmark analysis confirmed the survival advantage among responders (HR: 0.31, 95% CI: 0.26–0.37; p < 0.0001). Multivariable Cox regression analysis identified objective response as an independent prognostic factor for overall survival (HR: 0.37, 95% CI: 0.24–0.57; p < 0.0001), along with tumor size (HR: 1.94, 95% CI: 1.54–2.43; p < 0.0001), tumor number (HR: 1.39, 95% CI: 1.14-1.70; p = 0.001), and alpha-fetoprotein level (HR: 1.23, 95% CI: 1.01–1.49; p = 0.04).
Conclusion
Objective response assessed by mRECIST is a robust independent prognostic factor for overall survival in intermediate-stage HCC patients treated with TACE. This finding highlights the clinical importance of achieving an early objective response in improve long-term outcomes. Further prospective studies are needed to validate this result and explore strategies to enhance response rates to TACE.