Objective Response by mRECIST is an Independent Prognostic Factor for Overall Survival in Intermediate Hepatocellular Carcinoma Undergoing Transarterial Chemoembolization

BackgroundThe prognostic value of objective response assessed by the modified Response Evaluation Criteria in Solid Tumors (mRECIST) remains insufficiently characterized in patients with intermediate-stage hepatocellular carcinoma (HCC) patients undergoing transarterial chemoembolization (TACE). AimThis study aimed to evaluate the association between objective response and overall survival in this patient population. MethodsA retrospective analysis was conducted on 812 patients with Barcelona Clinic Liver Cancer (BCLC) stage B HCC who received TACE as first-line therapy at a tertiary hospital in China between January 2007 and May 2012. Patients were classified as responders (complete or partial response) or non-responders (stable or progressive disease) based on mRECIST criteria at the first follow-up after TACE. Baseline characteristics, including tumor size, number, and alpha-fetoprotein levels, were recorded. Overall survival was estimated using Kaplan-Meier analysis, and potential prognostic factors were evaluated using Cox proportional hazards models. ResultsThe objective response rate according to mRECIST was 63.2% (513/812). Responders demonstrated significantly longer median overall survival compared to non-responders (44.0 months vs. 10.9 months; hazards ratio [HR]: 0.31, 95% CI: 0.26-0.38; p < 0.0001). Landmark analysis confirmed the survival advantage among responders (HR: 0.31, 95% CI: 0.26-0.37; p < 0.0001). Multivariable Cox regression analysis identified objective response as an independent prognostic factor for overall survival (HR: 0.37, 95% CI: 0.24-0.57; p < 0.0001), along with tumor size (HR: 1.94, 95% CI: 1.54-2.43; p < 0.0001), tumor number (HR: 1.39, 95% CI: 1.14-1.70; p = 0.001), and alpha-fetoprotein level (HR: 1.23, 95% CI: 1.01-1.49; p = 0.04). ConclusionObjective response assessed by mRECIST is a robust independent prognostic factor for overall survival in intermediate-stage HCC patients treated with TACE. This finding highlights the clinical importance of achieving an early objective response in improve long-term outcomes. Further prospective studies are needed to validate this result and explore strategies to enhance response rates to TACE.