Vessels That Encapsulate Tumor Clusters(VETC) Predicts CTACE Response In Hepatocellular Carcinoma

Background:To investigate the correlation between pathological types of hepatocelllular carcinoma(HCC)and conventional transarterial chemoembolization(cTACE),and to evaluate the predictive value of the pathological types for efficacy of cTACE.METHODS:186 naive HCC patients from 2 hospitals,including 63 patients with recurrence after surgical resection and unresectable 123 cases,who underwent at least once cTACE procedure as the first treatment,were investigated.All patients were histologically diagnosed HCC by surgical resection and/or liver biopsy.Lipiodol deposition rate,ORR(objective response rate),PFS(progression free survival),OS(overall survival)were compared among different HCC pathological types.Results:This study evaluated 186 naive HCC patients and 189 tumor nodules.Vessels that encapsulate tumor clusters(VETC),macrotrabecular-massive(MTMT),CK19-positive types were identified in 38%(72/189),40%(76/189),and 28%(53/189)of the whole cohort,respectively(38%(24/63),44%(28/63),27%(17/63)of recurrence after surgical resection cohort;38%(48/126),38%(48/126),28%(35/126)of liver biopsy cohort).MTM and VETC types were also closely relevant to HBV DNA(>1000 IU/mL),high AFP level(>400 ng/mL),and PVT(P<0.05).There was very obvious correlation for CK19-positive type and lymph node,extrohepatic metastasis(P<0.05).ORR to the first cTACE was 41%(77/189)in the whole cohort(38%(24/63),recurrence after surgical resection;42%(53/126),liver biopsy cohort).VETC,MTM and CK19 negative HCCs derived significantly better lipiodol deposition rate and ORR.cTACE prolonged the PFS of VETC and CK19 negative HCCs compared with non-VETC and CK19-positive HCCs in the recurrence,liver biopsy and combining whole cohorts,whereas the OS of different pathological types were not significantly different.Multivariate analysis showed that VETC(OR,4.671,95%CI[1.954,11.166],P<0.001)and CK19-positive type(OR,0.127,95%CI[0.044,0.362],P<0.001)were independent predictive factors for the first cTACE response.However,only VETC type was significantly associated with the second cTACE response in multivariate analysis(OR,3.31,95%CI[1.24,8.83],P=0.017),suggesting that VETC might a more useful predictor of cTACE response.Conclusions:Our study suggests that VETC is an effective predictor of cTACE response in patients with HCC.