Radiological characteristics for guiding intra-arterial therapy in intermediate-stage hepatocellular carcinoma.

[BACKGROUND] To evaluate and contrast the efficacy and safety of trans-arterial chemoembolization (TACE) versus hepatic arterial infusion chemotherapy (HAIC) for intermediate-stage hepatocellular carcinoma (HCC) based on varying radiologic patterns.

[METHODS] A retrospective study identified 3,060 consecutive patients with intermediate-stage HCC who underwent initial TACE or HAIC between January 2009 and December 2022. HCC radiological features were categorized into pseudo-capsulated, pseudocapsule breakthrough, confluent multinodular, and infiltrative types. The propensity score matching (PSM) method was employed to minimize selection bias. The progression-free survival (PFS) was compared using the Kaplan-Meier method with the log-rank test. Independent prognostic factors were assessed using a forward stepwise Cox regression model in multivariable analyses.

[RESULTS] After propensity score matching, each group in the infiltrative HCC cohort included 237 patients, while the non-infiltrative HCC cohort comprised 262 patients per group. Notably, radiologic patterns were shown with statistical significance in three groups with different tumor burden (P < 0.001). Pseudo-capsulated type was dominant (55.6%) in < 6 cohorts, and infiltrative type was dominant (49.5%) in > 12 cohorts. A higher PFS was observed in the HAIC group compared to the TACE group in the infiltrative HCC cohort (P < 0.001), but comparable PFS was found between the two groups in the non-infiltrative HCC cohort (P = 0.532). In the multivariate analysis, both tumor burden and radiologic morphology showed significant associations with PFS.

[CONCLUSIONS] HAIC showed favorable outcomes in infiltrative HCC and might warrant further consideration in treatment planning.