Recurrences of Hepatocellular Carcinoma Following Initial Remission by Transarterial Chemoembolization

Lee, Jae Kyun; Chung, Young Hwa; Song, Byung Cheol; Yang, Soo Hyun; Choi, Won Bum; Yoon, Hyun Ki; Sung, Kyu Bo; Lee, Yung Sang; Suh, Dong Jin

Abstract

BACKGROUND/AIMS
We aimed to evaluate the recurrence rate of hepatocellular carcinoma (HCC) with initial excellent response by transarterial chemoembolization (TACE), and to find a better surveillance method that can detect the recurrent HCC of the early stage and ultimately improve the therapeutic efficacy of TACE. METHODS: Out of 230 consecutive HCC patients treated with TACE, 77 showing remission, were followed prospectively for more than 12 months. Remission was defined as the case of no additional lipiodol uptake and no additional tumor vessel. Serum alpha-fetoprotein (AFP) levels and computerized tomography (CT) scans were examined every 3 months to detect recurrent HCCs. Hepatic angiography was also performed at the same interval; if no recurrence, 6 months later; after then, every 12 months. RESULTS: Recurrent HCCs were detected in 40 patients after median 27 months of follow-up period. The recurrence rate of single nodular HCCs was lower than multinodular type. Local recurrence of HCCs with homogeneous lipiodol uptake was less frequent than that of HCCs with heterogeneous uptake. The 37% of recurrences were adjacent to original tumors and the 55% of recurrences were separated from them. The other 8% of recurrences occurred at both places. Among 40 recurrent cases, we detected 18 cases by serum AFP and CT scan, 19 cases by angiography, only 3 cases by lipiodol CT scan. The survival rates of HCC patients showing initial remission by TACE at 1, 2, and 3 year were 99%, 86%, and 64%, respectively. CONCLUSIONS: Our data indicate that regular angiography in addition to serum AFP and CT scan may be valuable in detecting recurrent HCCs and eventually improving the therapeutic effects of TACE. It also suggests that local injection therapy may be required to reduce recurrence, especially in HCCs with heterogeneous lipiodol uptake.