An increase in lesion density can predict lower local recurrence after transarterial chemoembolization in patients with hepatocellular carcinoma

Background/Aims: The purpose of this retrospective study was to determine the characteristics of hepatocellular carcinoma (HCC) associated with lower, local recurrence rates after transcatheter arterial chemoembolization (TACE). Methodology: From 2005 to 2012, 93 consecutive patients with 125 nodules were included in this study. Patients were included if they had fewer than 3 hypervascular tumors, smaller than 4cm in diameter. Patients were excluded if they had a lack of iodized oil accumulation in target nodules on non-enhanced computed tomography (CT) immediately after TACE treatment. Mean lesion density in Hounsfield units (HU) was measured on non-enhanced CT imaging immediately after and 1 week after TACE. Results: The median lesion density on CT was 625HU (range 138-1911) immediately after and 431HU (range 89-2145) 1 week after TACE. Multivariate analysis using the Cox proportional hazard model revealed that an increase in lesion density (hazard ratio (HR), 0.18; p=0.002), des-gamma-carboxy prothrombin concentration (HR, 2.21; p=0.01), and lesion density on CT 1 week after TACE (HR, 0.46; p=0.02) were significant independent predictors associated with the lower, local recurrence rate after TACE treatment. Conclusions: In HCC without increased lesion density 1 week after TACE, it is possible to consider alternative or adjuvant treatments.