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Article Type

Review

Abstract

Background The initial approach in the management of hepatocellular carcinoma (HCC) is to determine if either surgical resection or liver transplantation is feasible. Unfortunately, more than three-quarters of the patients are diagnosed during the intermediate or advanced stages of the disease and are considered ineligible for curative resection. Transarterial chemoembolization (TACE) is the current standard of therapy for patients with intermediate-stage HCC according to the Barcelona Clinic Liver Cancer classification. Aim This study aims to evaluate the role of triphasic computed tomography (CT) in the prediction of the prognosis of irresectable HCC patients, who had been locally treated with TACE by studying the enhancement (vascularity) pattern and the volume changes of the HCC after TACE. Patients and methods Our study included 25 HCC patients as diagnosed by triphasic CT study and serum alpha fetoprotein (AFP) level. The patients were recruited from the National Liver Institute Menoufia HCC Clinic and Radiology Department for assessment of the target lesion after doing TACE as a locoregional therapy for HCC from September 2017 to July 2018. Results Prediction model of response in our study depends on all of these variables along with the maximum initial diameter of the target lesion, the baseline serum AFP level, serum level of total bilirubin, INR, splenic size and sex of the patient with an overall accuracy of 88%, sensitivity of 93.3%, specificity of 80%, PPV: 87.5%, and NPV: 88.88%. Conclusion Triphasic CT is the most commonly used as the standard imaging technique for predicting and evaluating the therapeutic response in patients with HCC after TACE. It is a more accurate prognostic factor than the AFP serum level estimation.

Keywords

AFP, chemoembolization, hepatocellular carcinoma, transarterial chemoembolization

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