Tumour Burden Score as a Predictor of Extrahepatic Progression After Transarterial Chemoembolization for Hepatocellular Carcinoma: An Observational Multicenter Study

ABSTRACT Background In patients with hepatocellular carcinoma (HCC), extrahepatic progression (EHP) has a known dismal meaning. We evaluated the incidence and risk factors of EHP in HCC patients treated with transarterial chemoembolization (TACE), and the predictive role of tumour burden. Methods From the ITA.LI.CA database, 890 HCC patients undergoing first‐line TACE were included. Tumour burden score (TBS) was calculated and, after identification of the best cut‐point value, incidence and predictors of EHP were compared between TBS‐low and TBS‐high groups. Independent predictors of EHP at the first progression episode or at any time during follow‐up were identified through multivariable Cox analysis. Results After TACE, 7.2% of patients experienced EHP at the first progression episode, while the overall EHP rate during the follow‐up was 26.1%. The best cut‐point for TBS was 3.66. TBS‐high group (> 3.66) showed a significantly higher proportion of EHP both at first progression (10.4% vs. 3.6%; p < 0.001) and overall (32.6% vs. 18.7%; p < 0.001) compared to the TBS‐low group. Moreover, TBS‐high patients had shorter progression‐free survival and overall survival. TBS‐high and AFP levels emerged as independent predictors of EHP at the first progression episode and during the follow‐up, and their combined evaluation accurately stratified patients for their risk of EHP. Conclusion Extrahepatic dissemination is infrequent in HCC patients treated with TACE. TBS is easily calculable and helps in identifying patients at higher risk of metastasis development.