Locoregional interventional therapy for hepatocellular carcinoma: radiologic and clinical factors predictive of untreatable progression and time to untreatable progression

In this retrospective cohort study, independent risk factors that influence untreatable progression (UP) and time to UP (TTUP) in patients with hepatocellular carcinoma (HCC) after locoregional interventional therapy were examined. The effects of initial response and best response on UP occurrence and TTUP after locoregional interventional therapy were evaluated. Data were collected from HCC patients who were initially treated with the drug-eluting beads-transcatheter arterial chemoembolization (DEB-TACE) procedure at our hospital from January 2017 to December 2022. Modified response evaluation criteria in solid tumors (m-RECIST) was used to evaluate the radiologic response of tumors. Logistic regression analysis was used to analyze the risk factors for UP in patients, and Cox regression analysis was used to discover independent variables that influenced TTUP. A total of 93 patients who initially underwent the DEB-TACE procedure were included. Subsequent to initial treatment, 50 patients continued with DEB-TACE treatment, while 43 received DEB-TACE and sequential thermal ablation treatment. The probability of developing UP was 82.8% (n = 77). Furthermore, 49 (52.7%) patients achieved an initial response, and 70 (75.3%) achieved the best response. Multivariate logistic regression analysis confirmed three independent risk factors of UP, namely, age (odds ratio [OR]: 0.950, = 0.044); initial response (OR: 0.177, = 0.020); and treatment regimen (OR: 7.133, = 0.007). Multivariate Cox regression found that total bilirubin (hazard ratio [HR]: 1.029, = 0.002), tumor distribution (HR: 1.752, = 0.034), Subjective Angiographic Chemoembolization Endpoint (SACE) classification (HR: 0.668, = 0.043), number of tumors (HR: 1.130, = 0.004), initial response (HR: 0.539, = 0.019), and treatment regimen (HR: 4.615, < 0.001) were independent variables that influenced TTUP. Age, initial response, and treatment regimen significantly affected the occurrence of UP in HCC patients. Initial response, SACE classification, treatment regimen, total bilirubin, number of tumors, and tumor distribution were significantly correlated with TTUP. The initial response following locoregional interventional therapy had greater effects on UP occurrence and TTUP than the best response.