Observation of Bubbles and Detection of Hepatocytes in the Portal Vein During Radiofrequency

an impact on survival or tumor response.Methods: We conducted a retrospective analysis of 158 cirrhotic patients who underwent 280 TACE treatments for hepatocellular carcinoma.Cytolysis was defined as an increase of AST value above 100 IU/L with at least doubling of the baseline value within the first five days following treatment.Our primary outcome was the 18 months survival rate following a first treatment of TACE.Secondary outcomes were the radiologic tumor response as measured according to the EASL guidelines (objective response defined as complete or partial response), mean time for disease progression and predictors of cytolysis.Results: Cytolysis was present in 126 patients and absent in 32 at the time of their first treatment.18 patients died and 29 had a surgical procedure (hepatectomy or transplant) in the cytolysis group versus 8 and 3 respectively in the group without cytolysis.Patients that had a surgical intervention were censored from the survival analysis.The death rate was 14% vs. 25% if cytolysis was present or absent respectively (adjusted hazard ratio of death in cytolysis group 0.7465 ; 95% CI 0.32-1.73,p = 0.49).Regarding the radiologic response, there was no difference in the proportion of treatments resulting in an objective response ( cytolysis: 71/201, cytolysis absent: 18/72, odds-ratio 0.6103 , 95% CI 0.3327-1.1197,p = 0.1107).The mean time for disease progression was 4.8 months in the cytolysis group and 4.04 months in the group without cytolysis (95% CI 3.8-5.6 vs. 2.86-5.22months respectively) and was not significantly different between the two groups (p=0.43).In a multivariate analysis, tumor size and AST value before treatment were the only predictors for the incidence of cytolysis.Conclusion: The occurrence of cytolysis after a TACE has no impact on survival at 18 months.It is not associated with a better radiologic response or time for disease progression and has no prognostic significance.