Prognostic Value of the Vascular Lake Phenomenon in Large Hepatocellular Carcinoma Following Conventional TACE: A Retrospective Study

Abstract

Rationale and Objectives

The study aimed to evaluate risk factors related to the vascular lake phenomenon (VLP) and its impact on prognosis in patients with large hepatocellular carcinoma (HCC) (≥5 cm) undergoing Conventional transarterial chemoembolization (cTACE).

Patients and Methods

This study included 149 patients with large HCC who initially underwent cTACE from July 2021 to July 2023. The univariate and multivariate analyses were conducted to find risk factors related to VLP. The overall survival (OS), progression-free survival (PFS), objective response rate (ORR), disease control rate (DCR), and postoperative complications were compared between the VLP group and the non-VLP group. The propensity score matching (PSM) was used to reduce selection bias.

Results

Among the 149 patients (mean age 65 ± 12 years; 120 male), 50 patients were in the VLP group. The VLP group had a significantly higher positive rate of Hepatitis B surface Antigen (HBsAg) (p = .006). After PSM, VLP was an independent factor associated with OS (p = .002, HR 0.39, 95% CI: 0.21, 0.72) and PFS (p = .002, HR 0.50, 95% CI: 0.32, 0.78). The VLP group showed significantly longer OS (19.1 months vs. 13.4 months, p = .005), longer PFS (11.2 months vs. 6.5 months, p = .006), higher ORR (34.0% vs 14.0%, p = .019), and higher DCR (62.0% vs 26.0%, p<.001) than the non-VLP group.

Conclusion

The presence of VLP in large HCC may correlate with a higher rate of HBsAg positivity. It can indicate improved survival outcomes and treatment response underwent cTACE treatment.

Summary

In hepatocellular carcinoma with a diameter greater than 5 cm, the presence of preoperative vascular lake phenomenon indicates better transarterial chemoembolization efficacy.