Long-Term Recurrence Analysis Post Drug Eluting Bead (DEB) Chemoembolization for Hepatocellular Carcinoma

Background/Aims: To determine long term outcomes, regarding recurrence and survival, in patients with HCC that achieved complete response after initial treatment with drug eluting beads (DEB) using DC bead loaded with doxorubicin (DEB-DOX). Methodology: Forty-five patients with HCC, not suitable for curative treatments that exhibited complete response (EASL criteria) to initial DEB-DOX treatment were retrospectively analyzed after a median follow-up period of 63 months. Child-Pugh class was A/B (62.2/37.8%) and mean lesion diameter 5.36 +/- 1.1 cm. Lesion morphology was one dominant <= 5 cm (53.3%), one dominant >5 cm (31.1%) and multifocal (15.6%). Results: At 5 years, overall survival was 62.2% and recurrence-free survival 8.9%. All deaths were related to tumor progression (31.1%) or complications of underlying liver disease (28.9%). Median time of initial recurrence from baseline treatment was 18 months (range 8-52). When recurrence occurred, a mean time interval between additional DEB-DOX procedures less than 9 months was correlated to a poorer prognosis (p = 0.025). Multivariate analysis identified Child-Pugh class at baseline (p = 0.048), combined therapy of recurrences with local ablation (p = 0.03) and number of DEB-DOX procedures (p = 0.037) as significant prognostic factors of 5-year survival. Lesion morphology displayed significance for recurrence-free survival (p = 0.014). Conclusions: Initial complete response to DEB-DOX ensures a favorable prognosis. However, management of recurrent tumors, which occur frequently mostly as new lesions, and preservation of underlying liver function appear to play a key role in prolonging survival.