ArticleJournal of hepatocellular carcinoma2026
Extent of Embolization as an Independent Prognostic Factor in Superselective Conventional Transarterial Chemoembolization for Hepatocellular Carcinoma.
Article in Journal of hepatocellular carcinoma, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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7 authors.
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Abstract
Purpose: Superselective conventional transarterial chemoembolization (ss‑cTACE) guided by angiography-multidetector CT (AMDCT) improves feeder detection but can broaden the treated territory and compromise hepatic reserve. We asked whether restricting the embolized area to <1 Couinaud sector‑equivalent is associated with better prognosis in treatment‑naïve hepatocellular carcinoma (HCC). Our primary estimand was the covariate‑adjusted hazard ratio (HR) comparing extended (≥1 sector‑equivalent) vs limited (<1 sector‑equivalent) embolization. Patients and Methods: We conducted a single‑center retrospective cohort including 195 consecutive patients with newly diagnosed HCC who underwent initial ss‑cTACE/AMDCT (2010‑10‑01 to 2023‑08‑31; median age 75 years). Post‑procedural imaging classified patients as Group L (<1 sector‑equivalent; n=136) or Group E (≥1; n=59). Endpoints were progression‑free survival (PFS) and overall survival (OS); liver‑related death was modeled with cause‑specific hazards. Multivariable Cox models were prespecified as primary, with propensity‑score overlap weighting as a complementary sensitivity analysis; short‑term hepatic safety was assessed by post‑TACE ALBI within 1 month. Results: Compared with Group L, Group E showed shorter PFS (median 7 vs 12 months; aHR 1.7, 95% CI 1.1-2.5; p =.01) and OS (median 21 vs 33 months; aHR 2.1, 95% CI 1.2-3.5; p =.003). Short‑term hepatic safety did not differ: the post‑TACE ALBI score assessed within 1 month was similar between groups (-2.1 ± 0.4 vs -2.0 ± 0.4; p =.16). In Group L, liver‑related survival exceeded OS (113 vs 57 months; p =.01). Adjusted analyses confirmed embolization extent as an independent prognostic factor beyond stage, tumor burden, location, and liver function (PFS aHR 1.7; OS aHR 2.1). Among Group L decedents, HBV/HCV was independently associated with liver‑related death (OR 6.9, 95% CI 1.8-34; p =0.009). Conclusion: During initial ss‑cTACE/AMDCT, restricting embolization to <1 sector‑equivalent was associated with longer PFS/OS and fewer liver‑related deaths, supporting treatment planning that minimizes ischemic parenchymal injury, particularly in older or vulnerable patients.
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