92 - Ten-year Survival Outcomes After Conventional Transarterial Chemoembolization for Hepatocellular Carcinoma in the Era of Cone-beam CT and Advanced Microcatheter Technology

Purpose: The purpose of this study is to evaluate the long-term survival outcomes of conventional TACE in hepatocellular carcinoma, incorporating recent advances in imaging and catheter technology. We present 10-year survival data from a large patient cohort, analyze outcomes according to disease stage, and compare results with emerging therapies. These findings aim to clarify the current clinical value of TACE and support evidence-based strategies for HCC management.

Materials and Methods: This retrospective study included patients who underwent conventional TACE as the initial treatment for HCC between 2010 and 2012. and patients were followed for up to 15.7 years. Multiple staging systems—including the BCLC, modified UICC, AJCC/UICC, Okuda, Cancer of the Liver Italian Program (CLIP), Hong Kong Liver Cancer (HKLC), Chinese Liver Cancer Staging (CLCS), Japan Integrated Staging (JIS), and Italian Liver Cancer (ITA.LI.CA)—were applied. TACE was performed using superselective microcatheterization with cone-beam computed tomography guidance. Survival was analyzed using the Kaplan–Meier method and log-rank tests. Prognostic performance of staging systems was compared using AIC, BIC, and C-index.

Results: Among 974 patients assessed, 734 were included in the analysis. The mean age was 60.6 ± 10.7 years (range, 27–89), with 606 men (82.4%) and 129 women (17.6%). Liver transplantation was performed in 42 patients during follow-up. The median follow-up duration was 36.2 months (range, 0.2–187.3). The HKLC staging system demonstrated the best prognostic performance, showing the lowest AIC (6546.240) and BIC (6581.061) values and the highest C-index (0.751). The next best-performing systems were the ITA.LI.CA and the AJCC 8th edition staging systems. In the BCLC staging system, the 10-year survival rates were 56.5% in stage 0, 38.3% in stage A, 22.7% in stage B, 6.5% in stage C, and 0% in stage D. The restricted mean survival in stage 0 reached 136.1 months, while the median survival was 90.2, 47.7, 12.7, and 7.7 months for stages A–D, respectively.

Conclusion: With innovations in cone-beam CT–guided imaging and refined microcatheter techniques, conventional TACE has shown more favorable survival outcomes than previously reported in the literature. This study provides updated survival information for patients undergoing TACE and demonstrates the prognostic value of various staging systems.